Individual
MRS. LISA MARIE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,BC
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
183455
MA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN27883
RI
Other
Enumeration date
09/28/2009
Last updated
09/28/2009
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