Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 376 | RI |
N | 207QA0505X | Family Doctor - Adult Medicine | 376 | RI |
NPI | 1295265627 |
---|---|
Provider Name | Kathryne Anne Leonard |
First Address | Cranston, RI 02910-4417 |
Second Address | Cranston, RI 02910-4417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |