Healthcare Provider Details

I. General information

NPI: 1194912402
Provider Name (Legal Business Name): KENDRA JEAN MENOCHE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAIN ST
WOONSOCKET RI
02895-3123
US

IV. Provider business mailing address

400 IRON MINE HILL RD
N SMITHFIELD RI
02896-8163
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-0900
  • Fax: 401-766-8737
Mailing address:
  • Phone: 401-765-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN35733
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: