Individual
PHOUANGMALY MIMI OUPRAVANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
538 WINTHROP ST, REHOBOTH, MA 02769-1227
(508) 336-9200
(508) 342-1917
Mailing address
45 FARNUM ST, BLACKSTONE, MA 01504-2224
(401) 692-1516
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2338222
MA
363L00000X
Nurse Practitioner
Primary
RN2338222
MA
Other
Enumeration date
03/08/2020
Last updated
01/19/2026
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