Healthcare Provider Details

I. General information

NPI: 1023390655
Provider Name (Legal Business Name): CAITLIN MARIE DACEY RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

IV. Provider business mailing address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

V. Phone/Fax

Practice location:
  • Phone: 617-971-2100
  • Fax: 617-983-1377
Mailing address:
  • Phone: 617-971-2100
  • Fax: 617-983-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number277386
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: