Provider Demographics
NPI:1831642610
Name:LANCIANI, KYLE LEIGH
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LEIGH
Last Name:LANCIANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MENDON RD
Mailing Address - Street 2:OCEAN STATE URGENT CARE
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3844
Mailing Address - Country:US
Mailing Address - Phone:401-642-2072
Mailing Address - Fax:
Practice Address - Street 1:2130 MENDON RD
Practice Address - Street 2:OCEAN STATE URGENT CARE
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3844
Practice Address - Country:US
Practice Address - Phone:401-642-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily