Healthcare Provider Details

I. General information

NPI: 1750285797
Provider Name (Legal Business Name): KATHERINE POULSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HIGHLAND AVE
WINCHESTER MA
01890-1496
US

IV. Provider business mailing address

1105 CONCORD AVE
BELMONT MA
02478-1017
US

V. Phone/Fax

Practice location:
  • Phone: 781-756-2240
  • Fax:
Mailing address:
  • Phone: 801-671-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License NumberRN255852
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: