Basic Information
| Provider Information | |||||||||
| NPI: | 1265888036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARREN | ||||||||
| FirstName: | NIKKI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KUMAR | ||||||||
| OtherFirstName: | NIKKI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017274800 | ||||||||
| FaxNumber: | 4019216924 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017274800 | ||||||||
| FaxNumber: | 4019216924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2016 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD16921 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.