Provider Demographics
NPI:1801335138
Name:PLASSE, LUCILLE ELLEN
Entity type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ELLEN
Last Name:PLASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LUCILLE
Other - Middle Name:ELLEN
Other - Last Name:BEAUDOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 OLD GREAT ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865
Mailing Address - Country:US
Mailing Address - Phone:401-766-1526
Mailing Address - Fax:
Practice Address - Street 1:19 OLD GREAT ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-766-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN29700163W00000X
RIMT01308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse