Provider Demographics
NPI:1881091627
Name:KASANOVICH, KRISTI (RN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KASANOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:DESJARLAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14 SKY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-8105
Mailing Address - Country:US
Mailing Address - Phone:401-465-8639
Mailing Address - Fax:
Practice Address - Street 1:351 MAIN ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:RI
Practice Address - Zip Code:02822
Practice Address - Country:US
Practice Address - Phone:401-568-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN53583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse