Individual
JENNA MUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
593 EDDY STREET, CLAVERICK 2, PROVIDENCE, RI 02903
(401) 444-4000
Mailing address
125 WHIPPLE ST STE 3, PROVIDENCE, RI 02908-3258
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01677
RI
363A00000X
Physician Assistant
PA60923118
WA
Other
Enumeration date
12/17/2018
Last updated
07/30/2024
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