Healthcare Provider Details

I. General information

NPI: 1457364101
Provider Name (Legal Business Name): KRISTEN M DUHAMEL MED, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROVIDENCE COLLEGE ALUMNI HALL 549 RIVER AVENUE
PROVIDENCE RI
02918-0001
US

IV. Provider business mailing address

PROVIDENCE COLLEGE ALUMNI HALL 549 RIVER AVENUE
PROVIDENCE RI
02918-0001
US

V. Phone/Fax

Practice location:
  • Phone: 401-865-2260
  • Fax: 401-865-2965
Mailing address:
  • Phone: 401-865-2260
  • Fax: 401-865-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00184
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: