Provider Demographics
NPI:1801921275
Name:DEARY, KATIE A (NP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:DEARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 FRANCIS STREET
Mailing Address - Street 2:LOWRY BUILDING 6TH FLOOR SUITE 6E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS STREET
Practice Address - Street 2:LOWRY BUILDING 6TH FLOOR SUITE 6E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2371
Practice Address - Country:US
Practice Address - Phone:617-632-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263797363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA263797OtherLICENSE