1679787469 NPI number — MS. ROBYN L KIEVIT RD, CFNP

Table of content: MS. ROBYN L KIEVIT RD, CFNP (NPI 1679787469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679787469 NPI number — MS. ROBYN L KIEVIT RD, CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIEVIT
Provider First Name:
ROBYN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679787469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 TEMPLE ST
Provider Second Line Business Mailing Address:
#5
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-4259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-838-4788
Provider Business Mailing Address Fax Number:
617-824-7897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 BOYLSTON ST
Provider Second Line Business Practice Location Address:
EMERSON COLLEGE CENTER FOR HEALTH & WELLNESS
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02116-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-824-8666
Provider Business Practice Location Address Fax Number:
617-824-7897
Provider Enumeration Date:
05/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  232083 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X , with the licence number: 1497 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)