Provider Demographics
NPI:1639506272
Name:MANDOLFI, KATHERINE MARY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:MANDOLFI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CEDAR POND DR APT 4
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0879
Mailing Address - Country:US
Mailing Address - Phone:401-828-8958
Mailing Address - Fax:
Practice Address - Street 1:40 CEDAR POND DR APT 4
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0879
Practice Address - Country:US
Practice Address - Phone:401-828-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN52452163W00000X, 163WD0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health