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Individual

MRS. MAUREEN DERMODY BOURIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, CDE

Contact information

Practice address
21 PARIS ST, PAWTUCKET, RI 02860-6128
(401) 728-6811
(401) 728-6811
Mailing address
21 PARIS ST, PAWTUCKET, RI 02860-6128
(401) 728-6811
(401) 728-6811

Taxonomy

Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
RN29363
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
21010-8
BLUE CROSS/BLUE SHIELD
RI
01
28124
NEIGHBORHOOD HEALTH PLAN
RI
01
405279
BLUECHIP
RI
01
63-00129
UNITED HEALTH CARE
RI
Enumeration date
06/20/2006
Last updated
07/08/2007
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