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1891132916
JENNIFER DETRISAC
PROVIDENCE, RI
NPI
1891132916
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
208000000X Pediatrics
(Licence: RI LP02788)
Enumeration Date
2013-05-30
Last Update Date
2016-02-22
Business Address
JENNIFER DETRISAC M.D.
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-444-4471
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Mailing Address
JENNIFER DETRISAC M.D.
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-444-4471
Copy
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