Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD14368 | RI |
Y | 111NI0900X | Internist | MD14368 | RI |
N | 208000000X | Pediatrician | MD14368 | RI |
NPI | 1003044256 |
---|---|
Provider Name | Dr. Stephanie P Favreau |
First Address | Warwick, RI 02886-1617 |
Second Address | Warwick, RI 02886-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 19/10/2020 |