Healthcare Provider Details

I. General information

NPI: 1538381231
Provider Name (Legal Business Name): CATHERINE CAILLOUETTE RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE DEPT OF
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE DEPT PLASTIC
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-2340
  • Fax:
Mailing address:
  • Phone: 617-355-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number190669
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number190669
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: