Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 229918 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | 229918 | MA |
NPI | 1043375090 |
---|---|
Provider Name | Kimberly A Capello |
First Address | Concord, MA 01742-3317 |
Second Address | Concord, MA 01742-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P67243 | (02) | MA |