Provider Demographics
NPI:1437613403
Name:KASHMANIAN, ALEXANDRA E (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:E
Last Name:KASHMANIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:E
Other - Last Name:DEUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:175 RICCI LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5918
Mailing Address - Country:US
Mailing Address - Phone:401-741-1073
Mailing Address - Fax:
Practice Address - Street 1:100 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4216
Practice Address - Country:US
Practice Address - Phone:401-782-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290026163W00000X, 367500000X
RIAPRN0223367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110151783AMedicaid