1902821770 NPI number — MARSHA FITTRO RN

Table of content: MARSHA FITTRO RN (NPI 1902821770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902821770 NPI number — MARSHA FITTRO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITTRO
Provider First Name:
MARSHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1902821770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
184 WAMPANOAG TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02915-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-435-5128
Provider Business Mailing Address Fax Number:
401-270-4704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 WAMPANOAG TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-435-5128
Provider Business Practice Location Address Fax Number:
401-270-4704
Provider Enumeration Date:
07/13/2006

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: 163WD0400X , with the licence number:  14926 , 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: 11450254 . This is a "UNITED HEALTHCARE OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 29238-2 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 30333 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".