Healthcare Provider Details

I. General information

NPI: 1952497034
Provider Name (Legal Business Name): KIM M FOOTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

2580 CRANBERRY HWY
WAREHAM MA
02571-1013
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2435
  • Fax: 401-729-3476
Mailing address:
  • Phone: 508-494-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA'36591
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: