Provider Demographics
NPI:1891873295
Name:RENDALL, KATHERINE M (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:RENDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:16 RED GATE RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3785
Mailing Address - Country:US
Mailing Address - Phone:508-838-9235
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:857-248-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA086867Medicare ID - Type Unspecified
Q32383Medicare UPIN