MEDICARE: KATHLEEN CASAMENTO 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	163WS0121X	Plastic Surgery Registered Nurse	RN199639	MA

General Provider Information

NPI Number	:	1639793375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CASAMENTO RN

Provider Business Mailing Address
First Line	:	28 JUNIPER RD
Second Line	:
City	:	UPTON
State	:	MA
Zip	:	01568-1481
Country	:	US
Telephone Number	:	617-755-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 E MAIN ST
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1763
Country	:	US
Telephone Number	:	617-755-2001
Fax Number	:

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/28/2020

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