Provider Demographics
NPI:1316993173
Name:MEDEIROS, KATHRYN A (RNC COHN-S)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:RNC COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:68 BARTLETT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1802
Mailing Address - Country:US
Mailing Address - Phone:161-763-2601
Mailing Address - Fax:161-763-2541
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:161-763-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN137632363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health