Healthcare Provider Details

I. General information

NPI: 1982310421
Provider Name (Legal Business Name): KEILA VIEIRA GUSMAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLEY ST
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

44 VILLAGE HILL LN
NATICK MA
01760-5700
US

V. Phone/Fax

Practice location:
  • Phone: 508-370-0113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2369838
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: