Provider Demographics
NPI:1871997460
Name:ANDERSON, CATHY LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:LEE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1340 SOLDIERS FIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1000
Mailing Address - Country:US
Mailing Address - Phone:866-510-3002
Mailing Address - Fax:617-663-6677
Practice Address - Street 1:1340 SOLDIERS FIELD RD STE 3
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1000
Practice Address - Country:US
Practice Address - Phone:866-510-3002
Practice Address - Fax:617-663-6677
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily