Healthcare Provider Details

I. General information

NPI: 1427873744
Provider Name (Legal Business Name): KATHLEEN MARY PRINGLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8581
  • Fax: 401-606-5877
Mailing address:
  • Phone: 401-444-8581
  • Fax: 401-606-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number51239
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: