Provider Demographics
NPI:1528055233
Name:LAURIA, PAMELA (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LAURIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:1598 S COUNTY TRL STE 201
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1762
Practice Address - Country:US
Practice Address - Phone:401-884-0333
Practice Address - Fax:401-884-0096
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003943OtherMEDICARE GROUP
RI9002846Medicaid
RI2846OtherBCBS OF RI
RI709003943OtherMEDICARE GROUP
RI2846OtherBCBS OF RI
RI007057263Medicare PIN
RI2846OtherBCBS OF RI