Provider Demographics
NPI:1841303963
Name:ABSALOM, KATHLEEN DOLORES (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DOLORES
Last Name:ABSALOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PRIMROSE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2659
Mailing Address - Country:US
Mailing Address - Phone:978-556-0100
Mailing Address - Fax:978-681-4507
Practice Address - Street 1:600 PRIMROSE ST STE 202
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2659
Practice Address - Country:US
Practice Address - Phone:978-556-0100
Practice Address - Fax:785-560-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274443164W00000X
MARN274443363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039976Medicaid
DEQ60889Medicare UPIN
DE1000039976Medicaid