Healthcare Provider Details

I. General information

NPI: 1134264492
Provider Name (Legal Business Name): KRISTIN MARIE ST. PIERRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WARREN BLDG 1122
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST WARREN BLDG 1122
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-1604
  • Fax:
Mailing address:
  • Phone: 617-724-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number254576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: