Provider Demographics
NPI:1740860717
Name:DE SOUSA, KAITLYN ELIZABETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:DE SOUSA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:ELIZABETH
Other - Last Name:ARBEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:13 SLOCUM ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-2781
Mailing Address - Country:US
Mailing Address - Phone:508-685-1373
Mailing Address - Fax:
Practice Address - Street 1:13 SLOCUM ST APT 1F
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-2781
Practice Address - Country:US
Practice Address - Phone:508-685-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN98814164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse