Provider Demographics
NPI:1104583491
Name:DISALVATORE, KAYLA ROSE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:DISALVATORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5916
Mailing Address - Country:US
Mailing Address - Phone:774-404-1146
Mailing Address - Fax:
Practice Address - Street 1:63 BRIGGS AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5916
Practice Address - Country:US
Practice Address - Phone:774-404-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2326253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse