Provider Demographics
NPI:1346214293
Name:BOTELHO, NANCY M (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:BOTELHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2401
Mailing Address - Country:US
Mailing Address - Phone:401-453-7953
Mailing Address - Fax:401-453-7790
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-453-7953
Practice Address - Fax:401-453-7790
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412985OtherBLUE CHIP
RI29978-3OtherBCBS OF RI
RI050483739OtherGREAT WEST HEALTH CARE
RI9003486Medicaid
RI709004159OtherMEDICARE GROUP
RI709004159OtherMEDICARE GROUP
RI412985OtherBLUE CHIP
RIQ17936Medicare UPIN