Healthcare Provider Details

I. General information

NPI: 1760133797
Provider Name (Legal Business Name): KARESSA VICTOR WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 07/18/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TOWER ST
SOMERVILLE MA
02143-1426
US

IV. Provider business mailing address

2 IMRIE ST
RANDOLPH MA
02368-1522
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-4500
  • Fax:
Mailing address:
  • Phone: 857-210-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2360544
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2360544
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: