Provider Demographics
NPI:1568262921
Name:FOOTE-KASSIN, BONNIE (RN BSN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:FOOTE-KASSIN
Suffix:
Gender:
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LONG POND DR
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3012
Mailing Address - Country:US
Mailing Address - Phone:978-421-6367
Mailing Address - Fax:
Practice Address - Street 1:81 HOPE AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2212
Practice Address - Country:US
Practice Address - Phone:774-303-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH081138-21163W00000X
MARN2334299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse