Provider Demographics
NPI:1881934578
Name:GONCALVES, KATELYN E (LPN, CPHT, RPHT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:E
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:LPN, CPHT, RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7037
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0019
Mailing Address - Country:US
Mailing Address - Phone:774-930-3989
Mailing Address - Fax:866-305-3779
Practice Address - Street 1:383 MAIN ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8006
Practice Address - Country:US
Practice Address - Phone:774-930-3989
Practice Address - Fax:866-305-3779
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89142164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse