Provider Demographics
NPI:1710633649
Name:SPEESE, KATHLEEN (CRNP, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SPEESE
Suffix:
Gender:F
Credentials:CRNP, WHNP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:C
Other - Last Name:SPEESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP, WHNP-BC
Mailing Address - Street 1:30 MAGNUS AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3807
Mailing Address - Country:US
Mailing Address - Phone:267-808-8996
Mailing Address - Fax:
Practice Address - Street 1:165 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5123
Practice Address - Country:US
Practice Address - Phone:617-657-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025060363LW0102X
MARN2375057207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health