1689667370 NPI number — MS. DIANE BROUSSEAU-PIZZI PCNS

Table of content: MS. DIANE BROUSSEAU-PIZZI PCNS (NPI 1689667370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689667370 NPI number — MS. DIANE BROUSSEAU-PIZZI PCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUSSEAU-PIZZI
Provider First Name:
DIANE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PCNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689667370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 REVERE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02893-3938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-965-1947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 REVERE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02893-3938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-965-1947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN23411 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: PNS00015 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 408600 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1021340 . This is a "NEIGHBORHOOD HLTH PLAN RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 463957 . This is a "TUFTS HLTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223229 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6265640 . This is a "UNITED HLTH OF NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DB35712 . This is a "MEDICAID RITE SHARE OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 349426 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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