Healthcare Provider Details

I. General information

NPI: 1093210536
Provider Name (Legal Business Name): KATHERINE ESPINAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARKET SQ
LYNN MA
01905-2420
US

IV. Provider business mailing address

29 MARKET SQ
LYNN MA
01905-2420
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax: 781-598-1050
Mailing address:
  • Phone: 781-581-3900
  • Fax: 781-598-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2321118
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: