Individual
SUSANNE G. DEFEDELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCNS
Contact information
Practice address
101 HIGGINSON AVE, SUITE 107 D, LINCOLN, RI 02865-2732
(401) 723-7007
Mailing address
101 HIGGINSON AVE, SUITE 107 D, LINCOLN, RI 02865-2732
(401) 723-7007
Taxonomy
Speciality
Code
Description
License number
State
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
Primary
PPNS00002
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27266-5
BCBS OF RI
RI
01
—
411680
BLUE CHIP OF RI
RI
05
—
SD51376
—
RI
Enumeration date
10/24/2006
Last updated
07/08/2007
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