1891819108 NPI number — MS. KAREN TAYLOR SOILES PT

Table of content: JENNIFER TRENARY CRNP (NPI 1821208349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891819108 NPI number — MS. KAREN TAYLOR SOILES PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOILES
Provider First Name:
KAREN
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1891819108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 DONCASTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02131-4610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-477-9454
Provider Business Mailing Address Fax Number:
617-553-4479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 PROVIDENCE HWY STE LOWER6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-6811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-646-0313
Provider Business Practice Location Address Fax Number:
617-553-4479
Provider Enumeration Date:
03/19/2007

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: 225100000X , with the licence number:  2305204518 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 9007 , 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)

  • Identifier: 1891819108 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538567557 . This is a "ORGANIZATIONAL NPI" identifier . This identifiers is of the category "OTHER".