Provider Demographics
NPI:1508019449
Name:CONGDON, KATHLEEN (RN, CDOE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CONGDON
Suffix:
Gender:F
Credentials:RN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1532
Mailing Address - Country:US
Mailing Address - Phone:401-732-3066
Mailing Address - Fax:401-732-3094
Practice Address - Street 1:2191 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1532
Practice Address - Country:US
Practice Address - Phone:401-732-3066
Practice Address - Fax:401-732-3094
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN20199163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator