Provider Demographics
NPI:1962954420
Name:GEORGOULIS, LINDSEY CATHERINE (RN, BSN)
Entity type:Individual
Prefix:MISS
First Name:LINDSEY
Middle Name:CATHERINE
Last Name:GEORGOULIS
Suffix:
Gender:F
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 1:44 ELM ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2229
Mailing Address - Country:US
Mailing Address - Phone:978-269-4137
Mailing Address - Fax:
Practice Address - Street 1:44 ELM ST
Practice Address - Street 2:APT 3
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2229
Practice Address - Country:US
Practice Address - Phone:978-269-4137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258801163WC0200X, 163WG0000X, 163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2258801OtherMASS BOARD OF REGISTERED NURSES LICENSE