Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN01111 | RI |
NPI | 1003103185 |
---|---|
Provider Name | Mrs. Halina Kuc-Mazgaj |
First Address | Providence, RI 02906-2853 |
Second Address | Providence, RI 02906-2853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 18/01/2017 |