Provider Demographics
NPI:1982242095
Name:KAFTAN, SUSAN AMANDA (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMANDA
Last Name:KAFTAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4903
Mailing Address - Country:US
Mailing Address - Phone:781-861-6785
Mailing Address - Fax:
Practice Address - Street 1:251 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4903
Practice Address - Country:US
Practice Address - Phone:781-861-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181562163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool