Healthcare Provider Details

I. General information

NPI: 1245641679
Provider Name (Legal Business Name): TIFFINI YOUNG-KERSHAW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST DAVOL 129
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

690 CANTON STREET SUITE 325
WESTWOOD MA
02090-2329
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4933
  • Fax: 401-444-5090
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN49969
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN213090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: