Healthcare Provider Details

I. General information

NPI: 1326783176
Provider Name (Legal Business Name): KAITLIN MARIE MURTHA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CANAL ST
MALDEN MA
02148-6701
US

IV. Provider business mailing address

9 EDGEMERE ST
MELROSE MA
02176-5403
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-0055
  • Fax:
Mailing address:
  • Phone: 610-428-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2328946
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: