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General NPI Number Information
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NPI Number | 1780063628
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Entity Type | Individual
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Provider Name | JEANNETTE M SORACE-BURTON NP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 530 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5762
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Country | US
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Telephone | 401-276-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 44 GRINNELL AVE
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City | TIVERTON
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State | RI
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Zip | 02878-1902
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Country | US
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Telephone | 781-234-4981
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN254301
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN254301
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN01925
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License Number State | RI
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