Provider Demographics
NPI:1275813248
Name:MEDEIROS, JANINE MARY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARY
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4003
Mailing Address - Country:US
Mailing Address - Phone:401-722-0081
Mailing Address - Fax:013-120-3184
Practice Address - Street 1:39 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4003
Practice Address - Country:US
Practice Address - Phone:401-722-0081
Practice Address - Fax:013-120-3184
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263949363LF0000X
RINPP37650363LF0000X, 163WS0200X
RIAPRN00052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool