Healthcare Provider Details

I. General information

NPI: 1861990582
Provider Name (Legal Business Name): KATIE DIANE BIAS MSN, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KATIE DIANE DUPUIS

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SILVER LAKE AVE APT 4
NEWTON MA
02458-1114
US

IV. Provider business mailing address

57 SILVER LAKE AVE APT 4
NEWTON MA
02458-1114
US

V. Phone/Fax

Practice location:
  • Phone: 413-210-0042
  • Fax:
Mailing address:
  • Phone: 413-210-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2313978
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN2313978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: