Provider Demographics
NPI:1295492411
Name:SEASIDE PRIMARY CARE
Entity type:Organization
Organization Name:SEASIDE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,APRN,FNP
Authorized Official - Phone:401-246-8496
Mailing Address - Street 1:27 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3107
Mailing Address - Country:US
Mailing Address - Phone:401-246-8496
Mailing Address - Fax:860-495-5116
Practice Address - Street 1:27 EAST AVE
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3107
Practice Address - Country:US
Practice Address - Phone:401-246-8496
Practice Address - Fax:860-495-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty