Individual
JENNIFER DETRISAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4471
(401) 444-7574
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4471
(401) 444-7574
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
LP02788
RI
Other
Enumeration date
05/30/2013
Last updated
02/22/2016
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