Provider Demographics
NPI:1144749649
Name:MONEYMAKER, NINA (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MONEYMAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:BARTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 PLAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4828
Practice Address - Country:US
Practice Address - Phone:401-453-7560
Practice Address - Fax:401-453-7573
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175289363LW0102X, 363LW0102X
RIAPRN03767363LW0102X
VA0001194191163W00000X
MDAC002457363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144749649Medicaid