Provider Demographics
NPI:1053380485
Name:COTELESO, KAREN ANN (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:COTELESO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1524
Mailing Address - Country:US
Mailing Address - Phone:508-869-6286
Mailing Address - Fax:
Practice Address - Street 1:136 HIGH STREET EXT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2056
Practice Address - Country:US
Practice Address - Phone:978-368-8956
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118234363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP0897Medicare ID - Type Unspecified
MAS49392Medicare UPIN