Provider Demographics
NPI:1659940393
Name:DEFUSCO, CHERIE A (RN)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:A
Last Name:DEFUSCO
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 1:1508 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-1131
Mailing Address - Country:US
Mailing Address - Phone:401-692-1156
Mailing Address - Fax:
Practice Address - Street 1:1508 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1131
Practice Address - Country:US
Practice Address - Phone:401-692-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN46484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINAOtherNA
NAOtherNA