Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1053935312 |
---|---|
Provider Name | Katrina Adora Despinos |
First Address | Nashville, TN 37207-2917 |
Second Address | Providence, RI 02904-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 07/07/2021 |