Provider Demographics
NPI:1053795021
Name:NAWROCKI, MAUREEN GRACE (DAC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:GRACE
Last Name:NAWROCKI
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 AQUIDNECK AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5205
Mailing Address - Country:US
Mailing Address - Phone:401-847-1096
Mailing Address - Fax:
Practice Address - Street 1:1150 AQUIDNECK AVE
Practice Address - Street 2:UNIT A
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5205
Practice Address - Country:US
Practice Address - Phone:401-847-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
RIDA00451171100000X
MA265076171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist