Provider Demographics
NPI:1750095493
Name:GENDREAU, DOREEN (EDD, APRN-PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:EDD, APRN-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WOODLAND CIR
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2632
Mailing Address - Country:US
Mailing Address - Phone:401-450-5222
Mailing Address - Fax:949-703-7946
Practice Address - Street 1:171 WOODLAND CIR
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-2632
Practice Address - Country:US
Practice Address - Phone:401-450-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03864363LP0808X, 363LP0808X
MARN229618163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health