Provider Demographics
NPI:1922018266
Name:STEELE, KATHLEEN S (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:STEELE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 WASHINGTON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4634
Mailing Address - Country:US
Mailing Address - Phone:617-728-6000
Mailing Address - Fax:617-728-6040
Practice Address - Street 1:294 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4634
Practice Address - Country:US
Practice Address - Phone:617-728-6000
Practice Address - Fax:617-728-6040
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176502363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2003OtherBLUE SHIELD OF MASS
MA0355500Medicaid
MA0355500Medicaid
MANP2003OtherBLUE SHIELD OF MASS