Healthcare Provider Details

I. General information

NPI: 1992129472
Provider Name (Legal Business Name): KATHLEEN RICHARDS HOLDT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL GRAY-BIGELOW 444
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL GRAY-BIGELOW 444
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3030
  • Fax:
Mailing address:
  • Phone: 617-726-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2290125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: