Provider Demographics
NPI:1336807106
Name:VEZIKOV, EMMA P (RN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:P
Last Name:VEZIKOV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GINGER TRL
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-8261
Mailing Address - Country:US
Mailing Address - Phone:401-865-0003
Mailing Address - Fax:
Practice Address - Street 1:40 GINGER TRL
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-8261
Practice Address - Country:US
Practice Address - Phone:401-865-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN51761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse