Provider Demographics
NPI:1063768612
Name:SAVASTANO, KATHERINE ADELE (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ADELE
Last Name:SAVASTANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ADELE
Other - Last Name:KEFALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:34 HAVERHILL STREET
Mailing Address - Street 2:GREATER LAWRENCE FAMILY HEALTH CENTER
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841
Mailing Address - Country:US
Mailing Address - Phone:978-686-0090
Mailing Address - Fax:978-687-2615
Practice Address - Street 1:34 HAVERHILL STREET
Practice Address - Street 2:GREATER LAWRENCE FAMILY HEALTH CENTER
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-687-2615
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner