Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN01482 | RI |
NPI | 1013469428 |
---|---|
Provider Name | Kendra Gagliardi |
First Address | Riverside, RI 02915-4623 |
Second Address | Cumberland, RI 02864-1413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2016 |
Last Update Date | 02/11/2016 |