Individual
ENIAYO EGBERONGBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1150 RESERVOIR AVE STE 203, CRANSTON, RI 02920-6043
(401) 259-0340
(401) 259-0340
Mailing address
1150 RESERVOIR AVE STE 203, CRANSTON, RI 02920-6043
(401) 259-0340
(401) 213-8538
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2330024
MA
163WP0808X
Psychiatric/Mental Health Registered Nurse
681574
NY
363LF0000X
Family Nurse Practitioner
APRN01722
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN01722
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN2330024
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363LP0808X
—
RI
Enumeration date
05/31/2017
Last updated
06/29/2021
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