Provider Demographics
NPI:1518914084
Name:IANNUCCI, KAREN J (RNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SCHOOL STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-724-0600
Mailing Address - Fax:401-724-8306
Practice Address - Street 1:333 SCHOOL STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-724-0600
Practice Address - Fax:401-724-8306
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI37530363LX0001X
RIRI27530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002304Medicaid
RI007007339Medicare ID - Type Unspecified
RI9002304Medicaid