| NPI | 1154087492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAN E IDAHOSA Owner 401-633-2577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2023-06-19 |