Provider Demographics
NPI:1184972507
Name:WATROBA, KERRY (FNP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:WATROBA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LOISELLE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1816
Mailing Address - Country:US
Mailing Address - Phone:988-886-2438
Mailing Address - Fax:
Practice Address - Street 1:174 LITTLETON RD
Practice Address - Street 2:MINUTECLINIC
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3191
Practice Address - Country:US
Practice Address - Phone:978-692-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2263956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily