Basic Information
| Provider Information | |||||||||
| NPI: | 1952302267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAWADLER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | DIANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, BC, FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KNOFF | ||||||||
| OtherFirstName: | ELLEN | ||||||||
| OtherMiddleName: | DIANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 64 FURNACE ST | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020672808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817847807 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1071 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021862302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173332394 | ||||||||
| FaxNumber: | 6173332029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 137476 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.