=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841340833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN A TEPPER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 06/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 VFW PKWY
-----------------------------------------------------
City | WEST ROXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02132-4927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-472-8790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 95
-----------------------------------------------------
City | DUXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02331-0095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-330-9895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 173998
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 173998
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------