Healthcare Provider Details

I. General information

NPI: 1669758306
Provider Name (Legal Business Name): KATHRYN C TAKAYOSHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN C SCHUETTINGER NP

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2258907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: