Provider Demographics
NPI:1548278864
Name:BLACK, ANN RAE (RN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:RAE
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2408
Mailing Address - Country:US
Mailing Address - Phone:508-994-0217
Mailing Address - Fax:
Practice Address - Street 1:175 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6006
Practice Address - Country:US
Practice Address - Phone:508-994-0217
Practice Address - Fax:508-994-5489
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI18686163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator