Healthcare Provider Details

I. General information

NPI: 1477943397
Provider Name (Legal Business Name): KATHRYN ANN BEAUCHAMP RN, MSN, CCRN, CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST BIGELOW 616
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST BIGELOW 616
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-3888
  • Fax: 617-724-4398
Mailing address:
  • Phone: 617-724-3888
  • Fax: 617-724-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN223795
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: