Basic Information
| Provider Information | |||||||||
| NPI: | 1598426421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | KAITLYN | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | RN, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 OLNEY ST APT 3F | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021213529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173684318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 45 DIMOCK ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021191208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174428800 | ||||||||
| FaxNumber: | 6175418472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2022 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2338208 | MA | N | Nursing Service Providers | Registered Nurse | 363LP2300X | RN2338208 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LW0102X | RN2338208 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.