Provider Demographics
NPI:1790892891
Name:PEAREARA-EAVES, JOANN (CNM)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:PEAREARA-EAVES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 EAST AVE
Mailing Address - Street 2:150
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-727-4800
Mailing Address - Fax:401-728-4437
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:150
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-727-4800
Practice Address - Fax:401-728-4437
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
RICNM00111367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003815Medicaid
RI9003815Medicaid
RI429003815Medicare ID - Type Unspecified