Basic Information
| Provider Information | |||||||||
| NPI: | 1912360397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | LUTSIYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IMBRAGIMOVA | ||||||||
| OtherFirstName: | LUTSIYA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1637 MINERAL SPRING AVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | NORTH PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029044042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013544400 | ||||||||
| FaxNumber: | 4013544474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1637 MINERAL SPRING AVE | ||||||||
| Address2: | STE 107 | ||||||||
| City: | NORTH PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029044042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013544400 | ||||||||
| FaxNumber: | 4013544474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN00892 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.