MEDICARE: KAILEY EMMA DEMOURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN2318157	MA

General Provider Information

NPI Number	:	1326816802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY EMMA DEMOURA

Provider Business Mailing Address
First Line	:	200 MILL RD
Second Line	:
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5252
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 MAIN ST
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1606
Country	:	US
Telephone Number	:	508-946-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	09/08/2024

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Directions to “ KAILEY EMMA DEMOURA ” Practice Location

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