Healthcare Provider Details

I. General information

NPI: 1558768242
Provider Name (Legal Business Name): EDITH KABUGA C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 32A
CANTON MA
02021-2853
US

IV. Provider business mailing address

1017 TURNPIKE ST STE 32A
CANTON MA
02021-2853
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7343
  • Fax:
Mailing address:
  • Phone: 781-236-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number275049
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number275049
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN275049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: