Healthcare Provider Details

I. General information

NPI: 1770919375
Provider Name (Legal Business Name): KAREN DEAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH SERVICE AVE
N PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

825 CHALKSTONE AVE N. CAMPUS BUSINESS OFFICE, ATTN: R. SOARES
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3193
  • Fax:
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00020
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: