Individual
LAILA M JONSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
195 COLLYER ST, SUITE 201, PROVIDENCE, RI 02904-1869
(401) 272-7799
(401) 272-9299
Mailing address
99 RIVER VUE AVE, WARWICK, RI 02889-4717
(401) 272-7799
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00219
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26576
BLUE SHIELD
RI
05
—
7007330
—
RI
Enumeration date
09/01/2006
Last updated
03/28/2008
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