1043885403 NPI number — KATHLEEN NARDELLA AND ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043885403 NPI number — KATHLEEN NARDELLA AND ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN NARDELLA AND ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1043885403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1280 CENTRE ST STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON CENTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02459-1553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-775-5373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 CENTRE ST STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02459-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-775-5373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
NARDELLA
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-775-5373

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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