Healthcare Provider Details

I. General information

NPI: 1487845608
Provider Name (Legal Business Name): KATHLEEN A CORRIGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGHLAND AVE SUITE 304
SALEM MA
01970-2185
US

IV. Provider business mailing address

340 MAIN STREET SUITE 670
WORCESTER MA
01608-1681
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-4171
  • Fax: 978-741-4283
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-798-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number138208
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: