Individual
ILSE JENOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD10752
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0158861
—
MA
01
—
11/09/2006
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
1336163088
NPI
RI
01
—
408921
BCBSRI
RI
05
—
7009395
—
RI
01
—
9300114370
RAILROAD MEDICARE
—
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
02/04/2010
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