MEDICARE: MRS. CAROLINE ANN HISTEN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0100X	Gastroenterology Registered Nurse	2270074	MA

General Provider Information

NPI Number	:	1205219052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE ANN HISTEN RN

Provider Business Mailing Address
First Line	:	56 OAKLAND AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-3741
Country	:	US
Telephone Number	:	617-953-1816
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 OAKLAND AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-3741
Country	:	US
Telephone Number	:	617-953-1816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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