Healthcare Provider Details

I. General information

NPI: 1457640518
Provider Name (Legal Business Name): CAROLINE BEALS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE 7 NORTH
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE 7 NORTH
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8076
  • Fax: 617-730-0902
Mailing address:
  • Phone: 617-355-8076
  • Fax: 617-730-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number189928
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: