Healthcare Provider Details

I. General information

NPI: 1053866384
Provider Name (Legal Business Name): CAITLIN DIONNE CERESIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BAKER AVE
CONCORD MA
01742
US

IV. Provider business mailing address

330 BAKER AVE
CONCORD MA
01742-2129
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-9350
  • Fax: 978-287-9358
Mailing address:
  • Phone: 782-879-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2265663
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2265663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: