Provider Demographics
NPI:1922431923
Name:COUSINEAU, KINDRA E (RN)
Entity Type:Individual
Prefix:MRS
First Name:KINDRA
Middle Name:E
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SH 310 STE 2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1436
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:
Practice Address - Street 1:80 SH 310 STE 2
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1436
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-465986163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse