Healthcare Provider Details

I. General information

NPI: 1285095919
Provider Name (Legal Business Name): KATHERINE GEHLY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SPARTAN ARROW RD
LITTLETON MA
01460-1229
US

IV. Provider business mailing address

33 SPARTAN ARROW RD
LITTLETON MA
01460-1229
US

V. Phone/Fax

Practice location:
  • Phone: 978-486-4290
  • Fax:
Mailing address:
  • Phone: 978-486-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN145863
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: