Individual
JODI B CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1150 RESERVOIR AVE STE 201, CRANSTON, RI 02920
(401) 943-1300
(401) 228-7109
Mailing address
1150 RESERVOIR AVE STE 201, CRANSTON, RI 02920-6043
(401) 943-1300
(401) 228-7109
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/16/2011
Last updated
06/29/2018
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