Provider Demographics
NPI:1043568827
Name:GAUDET, KACIE KIYOKO NAKAMURA (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:KIYOKO NAKAMURA
Last Name:GAUDET
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3181
Mailing Address - Country:US
Mailing Address - Phone:617-480-7601
Mailing Address - Fax:
Practice Address - Street 1:6 RESNIK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4873
Practice Address - Country:US
Practice Address - Phone:508-747-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274692363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
20121631OtherPEDIATRIC NURSING CERTIFICATION BOARD