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Individual

CAASI BAIMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RNP

Contact information

Practice address
41 SANDERSON RD, SUITE 201, SMITHFIELD, RI 02917-2602
(401) 949-0300
(401) 349-3387
Mailing address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN00619
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05-0483739
TAX ID #
RI
05
1629456371
RI
01
709004048
MEDICARE GROUP PTAN
RI
Enumeration date
05/14/2015
Last updated
04/02/2024
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