=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508185182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE LEMME PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2010
-----------------------------------------------------
Last Update Date | 09/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 DUDLEY ST SUITE 470
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-444-7304
-----------------------------------------------------
Fax | 401-444-6681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16149
-----------------------------------------------------
City | RUMFORD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02916-0697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-453-9625
-----------------------------------------------------
Fax | 401-435-7069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | PA00558
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------