Individual
MRS. KATHERINE VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
235 N PEARL ST, BROCKTON, MA 02301-1794
(508) 427-2795
Mailing address
235 N PEARL ST, BROCKTON, MA 02301-1794
(508) 427-2795
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
254731
MA
363LG0600X
Gerontology Nurse Practitioner
254731
MA
Other
Enumeration date
08/31/2010
Last updated
10/20/2011
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