Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN01949 | RI |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN01949 | RI |
NPI | 1003383795 |
---|---|
Provider Name | Phina A Mayu |
First Address | Providence, RI 02905-5010 |
Second Address | Providence, RI 02904-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 16/02/2020 |