Basic Information
| Provider Information | |||||||||
| NPI: | 1710089883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POIRIER-WOOLF | ||||||||
| FirstName: | MICHELINE | ||||||||
| MiddleName: | LISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 MACINTOSH LN | ||||||||
| Address2: | |||||||||
| City: | SAUNDERSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028741938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012947054 | ||||||||
| FaxNumber: | 4017322763 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 BALD HILL RD STE 511 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028866100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017388100 | ||||||||
| FaxNumber: | 4017322763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NPP30927 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 30599-2 | 01 | RI | BCBS | OTHER | NPP30927 | 01 | RI | NURSE PRACTITIONER LICENS | OTHER | 404468 | 01 | RI | BCHIP | OTHER |