Healthcare Provider Details

I. General information

NPI: 1043269483
Provider Name (Legal Business Name): DIANE M KOTSAFTIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 KING STREET SUITE 3
LITTLETON MA
01460
US

IV. Provider business mailing address

531 KING STREET SUITE 3 PO BOX 1522
LITTLETON MA
01460
US

V. Phone/Fax

Practice location:
  • Phone: 978-486-9898
  • Fax: 978-486-9770
Mailing address:
  • Phone: 978-486-9898
  • Fax: 978-486-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number86736
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: