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NPI Code Detail

MEDICARE: JEREMY DANIEL DIBIASIO

MEDICARE: JEREMY DANIEL DIBIASIO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN02742RI
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1114533783
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY DANIEL DIBIASIO
Provider Business Mailing Address
First Line : 17 AIRPORT RD
Second Line :
City : WARWICK
State : RI
Zip : 02889-1001
Country : US
Telephone Number : 401-606-2520
Fax Number :
Provider Business Practice Location Address
First Line : 17 AIRPORT RD
Second Line :
City : WARWICK
State : RI
Zip : 02889-1001
Country : US
Telephone Number : 401-606-2520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2020
Last Update Date : 09/09/2021

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Directions to “ JEREMY DANIEL DIBIASIO ” Practice Location

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