Healthcare Provider Details

I. General information

NPI: 1245210798
Provider Name (Legal Business Name): GERALDINE A. KASULINOUS APRN, PC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MILLER ST UNIT 71
LUDLOW MA
01056-1503
US

IV. Provider business mailing address

308 MILLER ST UNIT 71
LUDLOW MA
01056-1503
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-7455
  • Fax: 413-789-7444
Mailing address:
  • Phone: 413-789-7455
  • Fax: 413-789-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number178541
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number178541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: