Provider Demographics
NPI:1518694355
Name:BERTHIAUME, KATHARINE A (CNP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:A
Last Name:BERTHIAUME
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRADFORD COMMONS LN
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8256
Mailing Address - Country:US
Mailing Address - Phone:508-887-3751
Mailing Address - Fax:
Practice Address - Street 1:100 BRIGHAM WAY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2445
Practice Address - Country:US
Practice Address - Phone:781-471-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278918363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care