Provider Demographics
NPI:1689667370
Name:BROUSSEAU-PIZZI, DIANE (PCNS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:BROUSSEAU-PIZZI
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-3938
Mailing Address - Country:US
Mailing Address - Phone:401-965-1947
Mailing Address - Fax:
Practice Address - Street 1:125 REVERE AVE
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-3938
Practice Address - Country:US
Practice Address - Phone:401-965-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN23411163W00000X
RIPNS00015364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI408600OtherBLUE CHIP OF RI
RI1021340OtherNEIGHBORHOOD HLTH PLAN RI
463957OtherTUFTS HLTH PLAN
RI223229OtherBCBS OF RI
6265640OtherUNITED HLTH OF NE
RIDB35712OtherMEDICAID RITE SHARE OF RI
MA349426OtherBCBS OF MA
RIDB35712OtherMEDICAID RITE SHARE OF RI
6265640OtherUNITED HLTH OF NE