Provider Demographics
NPI:1821268301
Name:PAVIDIS, KATHYLENE F (RN, MS)
Entity Type:Individual
Prefix:MS
First Name:KATHYLENE
Middle Name:F
Last Name:PAVIDIS
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-4222
Mailing Address - Fax:
Practice Address - Street 1:1010 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2600
Practice Address - Country:US
Practice Address - Phone:617-534-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179919163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care