Individual
KATHLEEN CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1000
(617) 421-6084
Mailing address
147 MILK ST, PROVIDER ENROLLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8053
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
152188
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
152188
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0704369
—
MA
01
—
AA34079
HARVARD PILGRIM
MA
01
—
NP9605
BLUE CROSS
MA
Enumeration date
02/14/2006
Last updated
05/02/2014
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