Provider Demographics
NPI:1124784905
Name:CHU, KAITLYN (NP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:551 BOYLSTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3680
Mailing Address - Country:US
Mailing Address - Phone:508-320-3289
Mailing Address - Fax:617-604-1830
Practice Address - Street 1:551 BOYLSTON ST STE 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3680
Practice Address - Country:US
Practice Address - Phone:617-658-3421
Practice Address - Fax:617-604-1830
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328690163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology