1881934578 NPI number — KATELYN E GONCALVES LPN, CPHT, RPHT

Table of content: KATELYN E GONCALVES LPN, CPHT, RPHT (NPI 1881934578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881934578 NPI number — KATELYN E GONCALVES LPN, CPHT, RPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONCALVES
Provider First Name:
KATELYN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN, CPHT, RPHT
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:
1881934578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7037
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-930-3989
Provider Business Mailing Address Fax Number:
866-305-3779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
383 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-8006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-930-3989
Provider Business Practice Location Address Fax Number:
866-305-3779
Provider Enumeration Date:
02/18/2013

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: 164W00000X , with the licence number:  LN89142 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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