Individual
JENNA MARIE IANNUCCILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 MASSASOIT AVE STE 300, EAST PROVIDENCE, RI 02914-2012
(401) 434-2704
(401) 434-4054
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
LP03816
RI
207R00000X
Internal Medicine Physician
Primary
MD16838
RI
Other
Enumeration date
07/13/2016
Last updated
01/19/2021
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