=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063713030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARA BETH CAVAZZA NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2010
-----------------------------------------------------
Last Update Date | 02/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 WINTER ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02108-4720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-426-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 KING AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-417-1323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | NPP37917
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------