Individual
JACQUELYNN M DIMUCCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1150 RESERVOIR AVE STE 203, CRANSTON, RI 02920-6043
(401) 259-0340
Mailing address
1150 RESERVOIR AVE STE 203, CRANSTON, RI 02920-6043
(401) 259-0340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01239
RI
Other
Enumeration date
05/11/2020
Last updated
10/06/2020
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