Individual
MR. ANDREW KOCIUBUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(401) 456-2000
(401) 456-2445
Mailing address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(401) 456-2445
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN.466178
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11039-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN.466178
REGISTERED NURSE
OH
Enumeration date
10/07/2020
Last updated
04/29/2026
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