Healthcare Provider Details

I. General information

NPI: 1629555784
Provider Name (Legal Business Name): KATHERINE ROSE BELLANTI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

1569 BEACON ST APT 63
BROOKLINE MA
02446-4613
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2320180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: