Basic Information
| Provider Information | |||||||||
| NPI: | 1790892891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEAREARA-EAVES | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 EAST AVE | ||||||||
| Address2: | 150 | ||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017274800 | ||||||||
| FaxNumber: | 4017284437 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 EAST AVE | ||||||||
| Address2: | 150 | ||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017274800 | ||||||||
| FaxNumber: | 4017284437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | N | Other Service Providers | Midwife | 367A00000X | CNM00111 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 9003815 | 05 | RI | MEDICAID |