Healthcare Provider Details

I. General information

NPI: 1215223011
Provider Name (Legal Business Name): CAITLIN A BURLESON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN A. HALL

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 320
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

630 PLANTATION ST WOT 12TH FL
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3140
  • Fax: 508-368-3196
Mailing address:
  • Phone: 508-368-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2268039
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number064334-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: