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General NPI Number Information
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NPI Number | 1811879448
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Entity Type | Individual
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Provider Name | THAIS RUDNICK WAHL
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 24 BEACH POINT DR
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City | RIVERSIDE
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State | RI
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Zip | 02915-2904
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Country | US
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Telephone | 508-493-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 24 BEACH POINT DR
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City | RIVERSIDE
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State | RI
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Zip | 02915-2904
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Country | US
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Telephone | 508-493-4585
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN10005342
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2295540
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 76425
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License Number State | RI
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