MEDICARE: MODUPE

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	313M00000X	Nursing Facility/Intermediate Care Facility	RN42505	RI

General Provider Information

NPI Number	:	1235676289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODUPE

Provider Business Mailing Address
First Line	:	1 KRISTEN DRIVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-2932
Country	:	US
Telephone Number	:	401-447-8569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KRISTEN DR
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-2932
Country	:	US
Telephone Number	:	401-447-8569
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	MS. MODUPE O WILLIAMS
Credential	:	RN
Telephone Number	:	401-447-8569

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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Directions to “MODUPE ” Practice Location

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