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General NPI Number Information
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NPI Number | 1780279232
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Entity Type | Individual
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Provider Name | KAITLYN MANLOVE AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/06/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1400 VFW PKWY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone | 857-203-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 COMMONWEALTH AVE APT 506
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City | BRIGHTON
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State | MA
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Zip | 02135-5942
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Country | US
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Telephone | 508-243-4761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN2308833
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2308833
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License Number State | MA
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