Individual
PANHA NGOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
530 N MAIN ST FL 4, PROVIDENCE, RI 02904-5762
(401) 582-0110
(401) 528-0188
Mailing address
164 NATICK AVE, CRANSTON, RI 02921-1106
(401) 209-7468
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN60515
RI
Other
Enumeration date
01/11/2019
Last updated
01/11/2019
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