Individual
KATHLEEN MARY CIVIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N
Contact information
Practice address
398 NEPONSET AVE, DORCHESTER, MA 02122-3134
(617) 533-2269
Mailing address
1135 MORTON ST, MATTAPAN, MA 02126-2834
(617) 533-2269
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN263050
MA
Other
Enumeration date
08/07/2015
Last updated
08/07/2015
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