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General NPI Number Information
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NPI Number | 1508701335
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Entity Type | Organization
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Legal Business Name | IASO HEALTH GROUP LLC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 201 WENTWORTH AVE
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City | CRANSTON
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State | RI
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Zip | 02905
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Country | US
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Telephone | 401-868-4691
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Fax | 401-340-1583
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Provider Business Mailing Address
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Address Line | 555 N MAIN ST # 1281
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City | PROVIDENCE
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State | RI
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Zip | 02904-5722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAIRE WICKS-TUCKER
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Credential | MSN, APRN, FNP-BC
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Telephone | 401-868-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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