Provider Demographics
NPI:1558016121
Name:BRUINS, AIREAL (CERTIFIED DOULA)
Entity type:Individual
Prefix:
First Name:AIREAL
Middle Name:
Last Name:BRUINS
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WEST AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3769
Mailing Address - Country:US
Mailing Address - Phone:323-842-6515
Mailing Address - Fax:
Practice Address - Street 1:199 WEST AVE APT 2L
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3769
Practice Address - Country:US
Practice Address - Phone:323-842-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3115526374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI87-4501550OtherNA