Basic Information
| Provider Information | |||||||||
| NPI: | 1558842112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOVAN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LINH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 HARVARD ST | ||||||||
| Address2: | |||||||||
| City: | MALDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021487902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178284794 | ||||||||
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| Practice Location | |||||||||
| Address1: | 297 PROMENADE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029085720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014906464 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2018 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNM00174 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.