Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | LPR00146 | RI |
NPI | 1013323419 |
---|---|
Provider Name | Ashley Nancy Mastrangelo |
First Address | Pawtucket, RI 02860-4474 |
Second Address | Pawtucket, RI 02860-4474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 07/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | RI |