Healthcare Provider Details

I. General information

NPI: 1588961858
Provider Name (Legal Business Name): BEATRICE BAMIKOLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 PARK ST STE 2
STOUGHTON MA
02072-3650
US

IV. Provider business mailing address

966 PARK ST STE 2
STOUGHTON MA
02072-3650
US

V. Phone/Fax

Practice location:
  • Phone: 781-885-7530
  • Fax: 855-284-1305
Mailing address:
  • Phone: 781-885-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2267018
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2267018
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: