Individual
KATELYN KANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
70 KENYON AVE STE 210, WAKEFIELD, RI 02879-4253
(401) 788-8780
(401) 788-8787
Mailing address
20 YORK ST, NEW HAVEN, CT 06510-3202
(203) 688-4242
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD19358
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
05/09/2018
Last updated
06/08/2023
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