Organization Name: | LIFESPAN PHYSICIAN GROUP, INC. |
NPI Number: | 1710382940 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY A WAKEFIELD (EXECUTIVE VP & CFO) |
Mailing Address: | 593 Eddy St Providence |
State: | RI US |
Postal Code: | 029034923 |
Phone Number: | 4014444318 |
Fax Number: | 4014446573 |
NPI Enumeration Date: | 10/30/2014 |
NPI Last Update Date: | 10/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |