Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NPP37209 | RI |
NPI | 1003821869 |
---|---|
Provider Name | Jennifer R Ouellette |
First Address | Bristol, RI 02809-4713 |
Second Address | Providence, RI 02908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 08/07/2007 |