Provider Demographics
NPI:1811452972
Name:CAPRA, KELLIE J (RN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:J
Last Name:CAPRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2828
Mailing Address - Country:US
Mailing Address - Phone:603-560-7558
Mailing Address - Fax:
Practice Address - Street 1:251 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4136
Practice Address - Country:US
Practice Address - Phone:978-475-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255647163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health