Provider Demographics
NPI:1932808532
Name:HOSTETTER, ENSLEY KENZIE
Entity Type:Individual
Prefix:
First Name:ENSLEY
Middle Name:KENZIE
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MILK ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3307
Mailing Address - Country:US
Mailing Address - Phone:774-487-4243
Mailing Address - Fax:
Practice Address - Street 1:190 MILK ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3307
Practice Address - Country:US
Practice Address - Phone:508-861-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program