NPI | 1306365812 |
---|---|
Entity Type | Organization |
Authorized Contact | MARCIA T POLHEMUS Controller 401-788-1974 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
207RA0000X Internal Medicine, Adolescent Medicine | |
363LA2200X Nurse Practitioner, Adult Health | |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2017-09-15 |
Last Update Date | 2022-02-10 |