Healthcare Provider Details

I. General information

NPI: 1588004527
Provider Name (Legal Business Name): JOAN BEI KIMA-TABONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARVARD RD
SHIRLEY MA
01464-2434
US

IV. Provider business mailing address

186 OLIN AVE
FITCHBURG MA
01420-7026
US

V. Phone/Fax

Practice location:
  • Phone: 978-425-4341
  • Fax: 508-792-7888
Mailing address:
  • Phone: 617-308-6130
  • Fax: 978-345-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number252502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: