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General NPI Number Information
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NPI Number | 1861528895
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Entity Type | Individual
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Provider Name | JOANNE ELIZABETH RODITAKIS FNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 164 SUMMIT AVE
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City | PROVIDENCE
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State | RI
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Zip | 02906-2853
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Country | US
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Telephone | 401-793-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 1284 COUNTY STREET UNIT #8
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City | ATTLEBORO
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State | MA
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Zip | 02703-3523
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Country | US
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Telephone | 774-254-3993
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NPP32221
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License Number State | RI
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