Provider Demographics
NPI:1578539151
Name:JADERQUIST-BASSETT, CATHLEEN DEE (NPP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:DEE
Last Name:JADERQUIST-BASSETT
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-0312
Mailing Address - Country:US
Mailing Address - Phone:401-647-3702
Mailing Address - Fax:401-647-5380
Practice Address - Street 1:142A DANIELSON PIKE
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1485
Practice Address - Country:US
Practice Address - Phone:401-647-3702
Practice Address - Fax:401-647-5380
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37159363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP44500Medicare UPIN