Provider Demographics
NPI:1386653343
Name:VANNIEUWENHUIZE, MICHELLE C (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:VANNIEUWENHUIZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL
Mailing Address - Street 2:BUILDING #3 SUITE 305
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1179
Mailing Address - Country:US
Mailing Address - Phone:401-334-1097
Mailing Address - Fax:401-305-5497
Practice Address - Street 1:6 BLACKSTONE VALLEY PL
Practice Address - Street 2:BUILDING #3 SUITE 305
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1179
Practice Address - Country:US
Practice Address - Phone:401-334-1097
Practice Address - Fax:401-305-5497
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29892-8OtherBLUE CROSS
RI412860OtherBLUE CHIP
RI29892-8OtherBLUE CROSS
I43719Medicare UPIN