MEDICARE: STEPHANIE CHURCH RN

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	163W00000X	Registered Nurse	RN60788	RI

General Provider Information

NPI Number	:	1699382861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CHURCH RN

Provider Business Mailing Address
First Line	:	37 SCENIC DR
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-1941
Country	:	US
Telephone Number	:	401-633-5184
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 HALLIGAN RD
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-3050
Country	:	US
Telephone Number	:	401-462-2592
Fax Number	:

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

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	05/05/2026

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