Healthcare Provider Details

I. General information

NPI: 1366572638
Provider Name (Legal Business Name): LESLEE KAGAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MERRIMAC ST 4TH FLOOR
BOSTON MA
02114-4714
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-6056
  • Fax: 617-643-6077
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number170092
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: