41D2186959 CLIA NUMBER - ERIKA FENN-VILLELLA RNP INC

Laboratory Demographics

CLIA Number: 41D2186959

Facility Name: ERIKA FENN-VILLELLA RNP INC

Facility Address:
22 BROOKFARM RD
NO PROVIDENCE, RI
ZIP 02904
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Facility Phone Number: 401 533-9399

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1629197355

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	41D2186959
LAB Type	Practitioner Other
Facility Name	ERIKA FENN-VILLELLA RNP INC
Street	22 BROOKFARM RD
City	NO PROVIDENCE
State	RI
ZIP	02904
Phone	401 533-9399
CertificateType	4
CertificateEffectiveDate	6/24/2022
CertificateExpirationDate	6/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024