Healthcare Provider Details

I. General information

NPI: 1215474077
Provider Name (Legal Business Name): KATHRYN MARY HURLEY PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN MARY O'BRIEN PNP-PC

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FIRST AVE 8TH FLOOR PEDIATRICS
CHARLESTOWN MA
02129
US

IV. Provider business mailing address

300 FIRST AVE 8TH FLOOR PEDIATRICS
CHARLESTOWN MA
02129
US

V. Phone/Fax

Practice location:
  • Phone: 617-952-5800
  • Fax: 617-952-5968
Mailing address:
  • Phone: 617-952-5800
  • Fax: 617-952-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2270489
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: