Healthcare Provider Details

I. General information

NPI: 1609061258
Provider Name (Legal Business Name): KATHLEEN ANN HANLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOUSATONIC ST
LEE MA
01238-1305
US

IV. Provider business mailing address

777 NORTH STREET
PITTSFIELD MA
01201
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-0805
  • Fax:
Mailing address:
  • Phone: 413-395-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number277180
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN277180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: