Provider Demographics
NPI:1699125617
Name:CHEA, CORVAH MENTEE (NP)
Entity type:Individual
Prefix:MR
First Name:CORVAH
Middle Name:MENTEE
Last Name:CHEA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CENTERVILLE ROAD
Mailing Address - Street 2:STE 102
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-773-7220
Mailing Address - Fax:401-773-7221
Practice Address - Street 1:535 CENTERVILLE ROAD
Practice Address - Street 2:STE 102
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-773-7220
Practice Address - Fax:401-773-7221
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily