MEDICARE: CAITLIN S REISMAN FNP-BC

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	363LF0000X	Family Nurse Practitioner	RN2267777	MA

General Provider Information

NPI Number	:	1366720534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN S REISMAN FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 760
Second Line	:
City	:	WINCHESTER
State	:	MA
Zip	:	01890-4260
Country	:	US
Telephone Number	:	781-756-7273
Fax Number	:	781-721-0725

Provider Business Practice Location Address
First Line	:	320 WASHINGTON ST
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02357-0001
Country	:	US
Telephone Number	:	508-565-1307
Fax Number	:	508-565-1510

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

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	09/30/2020

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