Healthcare Provider Details

I. General information

NPI: 1245848100
Provider Name (Legal Business Name): KATRINA ALICIA GOMEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

IV. Provider business mailing address

800 W CUMMINGS PARK STE 4050
WOBURN MA
01801-6372
US

V. Phone/Fax

Practice location:
  • Phone: 781-787-3003
  • Fax:
Mailing address:
  • Phone: 781-787-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2306732
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2306732
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN2306732
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: