Provider Demographics
NPI:1144374513
Name:THERRIEN, KATHRYN M (PNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4067
Mailing Address - Country:US
Mailing Address - Phone:978-406-4234
Mailing Address - Fax:
Practice Address - Street 1:480 MAPLE ST STE 3A
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4067
Practice Address - Country:US
Practice Address - Phone:978-406-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150950363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics