Healthcare Provider Details

I. General information

NPI: 1265406847
Provider Name (Legal Business Name): KATHLEEN A COLEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST GI LIVER GROUP P.C.TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

IV. Provider business mailing address

1 KENALRAY RD
AUBURN MA
01501-2209
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-9502
  • Fax:
Mailing address:
  • Phone: 508-832-2039
  • Fax: 508-334-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number146976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: