Basic Information
| Provider Information | |||||||||
| NPI: | 1730730904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORENCY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 186 PROVIDENCE ST | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016152800 | ||||||||
| FaxNumber: | 4016152805 | ||||||||
| Practice Location | |||||||||
| Address1: | 186 PROVIDENCE ST | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016152800 | ||||||||
| FaxNumber: | 4016152805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2019 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN02388 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1730730904 | 01 | NPI | OTHER | 1730730904 | 05 | RI | MEDICAID | APRN02388 | 01 | RI | APRN - RI | OTHER | CAPRN02388 | 01 | CSR | OTHER |