Organization
OCEAN STATE PRIMARY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZUBA (DIRECTOR OF OPERATIONS)
(401) 626-2748
Entity
Organization
Contact information
Practice address
300 TOLL GATE RD STE 101B, WARWICK, RI 02886-4447
(401) 921-5855
Mailing address
2130 MENDON RD STE 3-333, CUMBERLAND, RI 02864-3844
(401) 353-1012
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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