Healthcare Provider Details

I. General information

NPI: 1811452972
Provider Name (Legal Business Name): KELLIE J CAPRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S MAIN ST
ANDOVER MA
01810-4136
US

IV. Provider business mailing address

107 PELHAM RD
SALEM NH
03079-2828
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-4503
  • Fax:
Mailing address:
  • Phone: 603-560-7558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number255647
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: