Provider Demographics
NPI:1609500164
Name:STEPHENS, KADINE KAMILIA (RN)
Entity Type:Individual
Prefix:
First Name:KADINE
Middle Name:KAMILIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-6049
Mailing Address - Country:US
Mailing Address - Phone:617-571-4377
Mailing Address - Fax:
Practice Address - Street 1:15 GEORGE ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-6049
Practice Address - Country:US
Practice Address - Phone:617-571-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse