Basic Information
Provider Information
NPI: 1346848082
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAYMOND
FirstName: HANNAH
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 375 ALLENS AVE
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029055010
CountryCode: US
TelephoneNumber: 4014440400
FaxNumber: 4017802565
Practice Location
Address1: 1 RANDALL SQ
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029042709
CountryCode: US
TelephoneNumber: 4012746339
FaxNumber: 4014536290
Other Information
ProviderEnumerationDate: 10/14/2020
LastUpdateDate: 09/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X54565RIN Nursing Service ProvidersRegistered Nurse 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
363LF0000XAPRN03219RIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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