Basic Information
| Provider Information | |||||||||
| NPI: | 1578935649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | MICHEAL | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN-CNP, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 LESLIE ST | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029102605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019469699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 BALD HILL RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017388100 | ||||||||
| FaxNumber: | 4017379934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN00743 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | APRN00743 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.