Basic Information
| Provider Information | |||||||||
| NPI: | 1457583247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAPOSO-BUSA | ||||||||
| FirstName: | KIM | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MILL RD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FAIRHAVEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027195252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089732000 | ||||||||
| FaxNumber: | 5089732001 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027203703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086797814 | ||||||||
| FaxNumber: | 5086797881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2009 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 253172 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | RN253172 | 01 | MA | LICENSE | OTHER |