Healthcare Provider Details

I. General information

NPI: 1114782810
Provider Name (Legal Business Name): CAROLINE KIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST STE 1
HOLYOKE MA
01040-5140
US

IV. Provider business mailing address

183 ELM ST
ENFIELD CT
06082-3807
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-1733
  • Fax:
Mailing address:
  • Phone: 860-805-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10001223
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: