Healthcare Provider Details

I. General information

NPI: 1043552052
Provider Name (Legal Business Name): KATERI EGAN MCGUINNESS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST PATA JACKSON 121
BOSTON MA
02114-2621
US

IV. Provider business mailing address

37 ESSEX ST #2
CHARLESTOWN MA
02129-1615
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-2105
  • Fax:
Mailing address:
  • Phone: 617-480-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN234628
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN234628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: