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General NPI Number Information
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NPI Number | 1710227269
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Entity Type | Individual
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Provider Name | MELISSA ELAINE DIVOLL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 19 FRIENDSHIP ST STE 150-160
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City | NEWPORT
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State | RI
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Zip | 02840-2272
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Country | US
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Telephone | 401-845-3800
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Fax | 401-845-1075
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Provider Business Mailing Address
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Address Line | 19 FRIENDSHIP ST STE 150-160
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City | NEWPORT
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State | RI
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Zip | 02840-2272
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Country | US
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Telephone | 401-845-3800
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Fax | 401-845-1075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | RT10429
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | TH2000
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN03882
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License Number State | RI
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