Healthcare Provider Details

I. General information

NPI: 1568566263
Provider Name (Legal Business Name): KIMBERLY ANN ST.ANDRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRIDGE WAY
PASCOAG RI
02859-3131
US

IV. Provider business mailing address

15 OAK VALLEY LANE
HARRISVILLE RI
02830
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-7661
  • Fax: 401-568-7949
Mailing address:
  • Phone: 401-678-0142
  • Fax: 401-568-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN33627
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: