Healthcare Provider Details

I. General information

NPI: 1558916320
Provider Name (Legal Business Name): ALPHONCINA JOHN KAIHURA SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAPLE ST STE 207
SPRINGFIELD MA
01105-1828
US

IV. Provider business mailing address

155 MAPLE ST STE 207
SPRINGFIELD MA
01105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 413-285-8722
  • Fax: 413-285-8642
Mailing address:
  • Phone: 413-285-8722
  • Fax: 413-285-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2331939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: