Provider Demographics
NPI:1992867873
Name:PROVERB, KRISTEN T (MSN RN NPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:T
Last Name:PROVERB
Suffix:
Gender:F
Credentials:MSN RN NPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MERRIMACK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-454-0706
Mailing Address - Fax:978-654-7978
Practice Address - Street 1:222 MERRIMACK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-454-0706
Practice Address - Fax:978-654-7978
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA258630363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine