Provider Demographics
NPI:1780063628
Name:SORACE-BURTON, JEANNETTE M (NP)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:SORACE-BURTON
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 1:44 GRINNELL AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1902
Mailing Address - Country:US
Mailing Address - Phone:781-234-4981
Mailing Address - Fax:
Practice Address - Street 1:251 MAIN ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:RI
Practice Address - Zip Code:02822-3531
Practice Address - Country:US
Practice Address - Phone:888-671-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN254301163W00000X, 363LP0808X
RIAPRN01925363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse