Healthcare Provider Details

I. General information

NPI: 1104946649
Provider Name (Legal Business Name): CATHLEEN MARY KILMARTIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CEDAR TREE NECK RD
MARSTONS MILLS MA
02648-1817
US

IV. Provider business mailing address

160 CEDAR TREE NECK RD
MARSTONS MILLS MA
02648-1817
US

V. Phone/Fax

Practice location:
  • Phone: 502-802-7005
  • Fax:
Mailing address:
  • Phone: 502-802-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number152366
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: