Provider Demographics
NPI:1346048097
Name:DEANGELIS, KRISTIN LYNN (RN, CLC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:DEANGELIS
Suffix:
Gender:
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4255
Mailing Address - Country:US
Mailing Address - Phone:339-793-3586
Mailing Address - Fax:
Practice Address - Street 1:354 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5538
Practice Address - Country:US
Practice Address - Phone:617-426-9200
Practice Address - Fax:617-426-9201
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA362564163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant