Provider Demographics
NPI:1942893789
Name:CARDENAS, MIRIAM (FNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MAIN ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3163
Mailing Address - Country:US
Mailing Address - Phone:401-886-9669
Mailing Address - Fax:401-886-9779
Practice Address - Street 1:1050 MAIN ST UNIT 18
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3163
Practice Address - Country:US
Practice Address - Phone:401-886-9669
Practice Address - Fax:401-886-9779
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2371791363LF0000X
RIAPRN03075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily