Provider Demographics
NPI:1053485185
Name:VINCENT, DEBRA ANNE (MA ,RDN,CDOE,CVDOE)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANNE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MA ,RDN,CDOE,CVDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TWIN BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-7512
Mailing Address - Country:US
Mailing Address - Phone:401-426-0018
Mailing Address - Fax:401-944-1812
Practice Address - Street 1:63 SOCKANOSSET CROSS RD
Practice Address - Street 2:SUITE A
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5557
Practice Address - Country:US
Practice Address - Phone:401-426-0018
Practice Address - Fax:401-944-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI676708133V00000X
RILDN00057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI403156OtherBLUE CHIP
RI256106OtherRI BLUE CROSS
RI719025610Medicare ID - Type Unspecified
RI256106OtherRI BLUE CROSS