Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NPP37746 | RI |
NPI | 1023350485 |
---|---|
Provider Name | Chanta Pou |
First Address | Woonsocket, RI 02895-3300 |
Second Address | Woonsocket, RI 02895-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 11/06/2014 |