Individual
LISA MARIE DEJESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
301 STATE AVE, TIVERTON, RI 02878-1062
(774) 300-3444
(774) 307-9039
Mailing address
301 STATE AVE, TIVERTON, RI 02878-1062
(774) 300-3444
(774) 307-9039
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN02508
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RNRN2272709
MA
Other
Enumeration date
02/29/2020
Last updated
10/08/2025
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