Individual
JOANNE CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
Mailing address
690 CANTON ST STE 325, WESTWOOD, MA 02090-2324
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN02006
RI
367500000X
Certified Registered Nurse Anesthetist
RN2305195
MA
367500000X
Certified Registered Nurse Anesthetist
RN50949
RI
Other
Enumeration date
02/14/2019
Last updated
02/22/2019
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