Provider Demographics
NPI:1790955391
Name:DEMELLO, PAULA JOYCE (RNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JOYCE
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JOYCE
Other - Last Name:BEAUREGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:148 W RIVER ST STE 8
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-606-3000
Practice Address - Fax:401-331-8110
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00871363LW0102X
MARN193415363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health