Provider Demographics
NPI:1285257725
Name:CHAUCER, KATIE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:NICOLE
Last Name:CHAUCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26 BOYLSTON RD APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 BOYLSTON RD APT 1
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1809
Practice Address - Country:US
Practice Address - Phone:317-471-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0135537363LP0200X
MARN2339427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse