NPI 1346746062 · live from the CMS NPI Registry
Traci M Bologna-Jill, DPM
Podiatrist, Foot & Ankle Surgery in Providence, RI. National Provider Identifier 1346746062, active.
NPI record
| NPI | 1346746062 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 1 Randall Sq Ste 408, Providence, RI 02904 |
| Practice phone | 401-453-2000 |
| Enumerated | April 2, 2018 |
| Last updated | December 15, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | DPM00367 (RI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.