=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457364101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN M DUHAMEL MED, ATC, CSCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PROVIDENCE COLLEGE ALUMNI HALL 549 RIVER AVENUE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02918-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-865-2260
-----------------------------------------------------
Fax | 401-865-2965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PROVIDENCE COLLEGE ALUMNI HALL 549 RIVER AVENUE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02918-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-865-2260
-----------------------------------------------------
Fax | 401-865-2965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT00184
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------