Healthcare Provider Details

I. General information

NPI: 1316993173
Provider Name (Legal Business Name): KATHRYN A MEDEIROS RNC COHN-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST
BOSTON MA
02115-6013
US

IV. Provider business mailing address

68 BARTLETT HILL RD
CONCORD MA
01742-1802
US

V. Phone/Fax

Practice location:
  • Phone: 161-763-2301
  • Fax:
Mailing address:
  • Phone: 161-763-2601
  • Fax: 161-763-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN137632
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: