Provider Demographics
NPI:1669122743
Name:FREITAS-LANDIM, CELITA MOREIRA
Entity type:Individual
Prefix:
First Name:CELITA
Middle Name:MOREIRA
Last Name:FREITAS-LANDIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CELITA
Other - Middle Name:MOREIRA
Other - Last Name:FREITAS-LANDIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-461-9110
Mailing Address - Fax:
Practice Address - Street 1:162 LEDGE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1552
Practice Address - Country:US
Practice Address - Phone:401-461-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse