1528239621 NPI number — VETERANS ADMINISTRATION MEDICAL CENTER

Table of content: NICOLE COVELL LISW (NPI 1275098006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528239621 NPI number — VETERANS ADMINISTRATION MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETERANS ADMINISTRATION MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1528239621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 STEUBEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02909-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-294-0223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 HEATHMAN ROAD
Provider Second Line Business Practice Location Address:
WHITE HALL, RM 309
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-874-5342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURROWS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL AFFAIRS OFFICER
Authorized Official Telephone Number:
401-273-7100

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  RN 38958 , 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)





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