Provider Demographics
NPI:1497709497
Name:DEMATTEO, IRENE (APRN, PCNS, RN, BC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:APRN, PCNS, RN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTERVILLE RD SUITE 101 WEST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0201
Mailing Address - Country:US
Mailing Address - Phone:401-480-9820
Mailing Address - Fax:401-842-0360
Practice Address - Street 1:300 CENTERVILLE RD SUITE 101 WEST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0201
Practice Address - Country:US
Practice Address - Phone:401-480-9820
Practice Address - Fax:401-842-0360
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00003101YP2500X
RIAPRN00188364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPENDINGMedicaid