Individual
KIMBERLY REARDON BANIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6162
(617) 730-0621
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115
(617) 355-6162
(617) 730-0621
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
209011064
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
RN2316271
MA
Other
Enumeration date
10/17/2014
Last updated
08/28/2017
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