Provider Demographics
NPI:1689658205
Name:GOLDEN MCANDREW, KATHLEEN ROSE (MSN, APRN, BC, ANP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ROSE
Last Name:GOLDEN MCANDREW
Suffix:
Gender:F
Credentials:MSN, APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 8TH ST
Mailing Address - Street 2:SUITE 5313
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-4207
Mailing Address - Country:US
Mailing Address - Phone:617-201-6407
Mailing Address - Fax:
Practice Address - Street 1:100 MORRISSEY BLVD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-3393
Practice Address - Country:US
Practice Address - Phone:617-287-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health