Provider Demographics
NPI:1962409706
Name:DWELLY, JOANN PATRICIA (RFM)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:PATRICIA
Last Name:DWELLY
Suffix:
Gender:F
Credentials:RFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SONGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2382
Mailing Address - Country:US
Mailing Address - Phone:401-835-1797
Mailing Address - Fax:508-636-4447
Practice Address - Street 1:177 SONGBIRD LN
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-2382
Practice Address - Country:US
Practice Address - Phone:401-835-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26904-9OtherBLUE CROSS/BLUE SHIELD
MA820956OtherTUFTS HEALTH PLAN
MA706247OtherHARVARD PILGRIM HEALTH
RI411281OtherBLUE CHIP
4883330001Medicare NSC