Healthcare Provider Details

I. General information

NPI: 1861903353
Provider Name (Legal Business Name): DAPHNIS COLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BAY DRIVE
CANTON MA
02021
US

IV. Provider business mailing address

211 BAY DR
CANTON MA
02021-4186
US

V. Phone/Fax

Practice location:
  • Phone: 774-360-0341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2281563
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: