Healthcare Provider Details

I. General information

NPI: 1326256207
Provider Name (Legal Business Name): LORRAINE THERESE KITCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST SURGICAL CLINICS SUITE 170
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

2 DUDLEY ST SURGICAL CLINICS SUITE 170
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN17362
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: