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General NPI Number Information
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NPI Number | 1932672110
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Entity Type | Organization
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Legal Business Name | YESSHAWNIECESTYLES
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1495 NEWPORT AVE
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City | PAWTUCKET
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State | RI
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Zip | 02861-1342
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Country | US
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Telephone | 401-388-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 NEWPORT AVE
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City | PAWTUCKET
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State | RI
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Zip | 02861-1342
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Country | US
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Telephone | 401-388-0309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWNIECE L JACKSON
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Credential |
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Telephone | 617-306-1809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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