Basic Information
| Provider Information | |||||||||
| NPI: | 1790782530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRENIER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 QUAKER LN | ||||||||
| Address2: | N. CAMPUS BUSINESS OFFICE, ATTN; R. SOARES | ||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028932151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012707077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 CHALKSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029084728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014562000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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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 | 363AS0400X | PA0139 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 7004755 | 05 | RI | MEDICAID |