Provider Demographics
NPI:1013975424
Name:FERREIRA, KRISTEN (NP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FERREIRA
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 1:8 COMMON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-4421
Mailing Address - Country:US
Mailing Address - Phone:781-647-3040
Mailing Address - Fax:781-647-3044
Practice Address - Street 1:8 COMMON ST
Practice Address - Street 2:STE 2
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-4421
Practice Address - Country:US
Practice Address - Phone:781-647-3040
Practice Address - Fax:781-647-3044
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0385701Medicaid
MA0385701Medicaid
MANP2818Medicare ID - Type Unspecified