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General NPI Number Information
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NPI Number | 1780492223
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Entity Type | Individual
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Provider Name | KEERTHANA RAO
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 529 TIMPANY BLVD
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City | GARDNER
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State | MA
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Zip | 01440-3451
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Country | US
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Telephone | 810-097-8878
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Fax |
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Provider Business Mailing Address
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Address Line | 255 NORTH RD UNIT 12
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City | CHELMSFORD
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State | MA
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Zip | 01824-1418
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Country | US
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Telephone | 978-652-8480
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2327404
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License Number State | MA
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