Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1104021112 |
---|---|
Provider Name | Jasmine Mena |
First Address | Kingston, RI 02881 |
Second Address | Kingston, RI 02881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 05/04/2010 |