Provider Demographics
NPI:1952302697
Name:HART, ELAINE DESROSIERS (NP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:DESROSIERS
Last Name:HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1126
Mailing Address - Country:US
Mailing Address - Phone:401-247-0610
Mailing Address - Fax:401-245-7362
Practice Address - Street 1:286 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3437
Practice Address - Country:US
Practice Address - Phone:401-247-0610
Practice Address - Fax:401-245-7362
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN 16786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI697704OtherHARVARD PILGRIM HEALTH
RIAD00546Medicaid
RI0000030891OtherB/S
RI406137OtherTUFTS HEALTH PLANS
RI04-00518OtherUNITED HEALTH CARE
RI405673OtherBCHIP
RI3862OtherNEIGHBORHOOH HEALTH PLANS
RI3862OtherNEIGHBORHOOH HEALTH PLANS