Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD9613 | RI |
N | 2086S0120X | Pediatric Surgery | RI9613 | RI |
NPI | 1316944127 |
---|---|
Provider Name | Arlet G. Kurkchubasche |
First Address | Rumford, RI 02916-0697 |
Second Address | Providence, RI 02905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3173780 | (05) | MA |
9020611 | (05) | RI |
G35010 | (02) |