Individual provider Active NPI

Donna Marie Rondeau-Marzullo, NP

  • Gerontology Nurse Practitioner
  • Riverside, RI
National Provider Identifier
1043409790
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN00484 Issued in RI
Practice address
375 Wampanoag TRL
Suite 102
Riverside, RI 02915-2232
Phone
(401) 649-4010
Fax
(401) 649-4011
NPI assigned
Oct 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN00484 RI Primary

Addresses

Primary practice location

375 Wampanoag TRL
Suite 102
Riverside, RI 02915-2232

Mailing address

110 Elm St
Providence, RI 02903-4626
Phone (877) 771-7401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080627000004 RI Practitioner - Nurse Practitioner 3072685643 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Medical Physicians IncGroup PAC ID 0345658316, 222 clinicians
Brown MedicineGroup PAC ID 0446159776, 220 clinicians

Practice addresses (Care Compare)

375 Wampanoag TRL
Riverside, RI 02915-2232
Phone (401) 649-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN00484RIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. CurrentSince Jan 31, 2026 Accepting new patients
Coastal Medical Physicians, Inc. CurrentSince Jan 31, 2026 Accepting new patients
Brown Medicine CurrentSince Jul 6, 2015 Accepting new patients
Brown Medicine CurrentSince Jul 6, 2015 Accepting new patients
Elmhurst Extended Care Facilities, Inc. Past Accepting new patients

Locations

593 Eddy St
Providence, RI 02903

50 Maude St
Providence, RI 02908
Phone (401) 456-2200

110 Elm St
Providence, RI 02903
Phone (401) 443-4992

375 Wampanoag Trl
Riverside, RI 02915
Phone (401) 649-4010

375 Wampanoag Trl
Ste 102
Riverside, RI 02915
Phone (401) 649-4010

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1043409790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELM ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034626",
            "telephone_number": "877-771-7401",
            "fax_number": "401-784-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WAMPANOAG TRL",
            "address_2": "SUITE 102",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152232",
            "telephone_number": "401-649-4010",
            "fax_number": "401-649-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONDEAU-MARZULLO",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-18",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "RI",
            "license": "APRN00484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.