=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659025831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RI WELLNESS MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2022
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1635 MINERAL SPRING AVE STE 203
-----------------------------------------------------
City | NORTH PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-525-8202
-----------------------------------------------------
Fax | 308-888-6638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1635 MINERAL SPRING AVE STE 203
-----------------------------------------------------
City | NORTH PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-525-8202
-----------------------------------------------------
Fax | 308-888-6638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | EUCHARIA U IBEH
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 401-525-8202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------