Healthcare Provider Details

I. General information

NPI: 1851309108
Provider Name (Legal Business Name): KATHERINE STEVENS LYMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST DIVISION OF GERONTOLOGY LMOB-1
BOSTON MA
02215-5501
US

IV. Provider business mailing address

23 PIPER RD
ACTON MA
01720-4440
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-8696
  • Fax: 617-632-8673
Mailing address:
  • Phone: 978-263-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number151955
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number151955
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: