MEDICARE: MS. LINDA LEE GADOURY CNS

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
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	RN14971	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22250-3	OTHER	RI	BLUE CROSS
2	406934	OTHER	RI	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1205804218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LEE GADOURY CNS

Provider Business Mailing Address
First Line	:	54 SHARPE ST
Second Line	:
City	:	WEST GREENWICH
State	:	RI
Zip	:	02817-2100
Country	:	US
Telephone Number	:	401-397-3750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD
Second Line	:	THE MEADOWS BLDG D 305A
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4161
Country	:	US
Telephone Number	:	401-294-8231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/24/2011

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