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Provider Information for 1831179050

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1831179050

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1831179050
Enumeration Date 2006-01-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 77 WARREN ST 3RD FLOOR
BRIGHTON, MA 02135-3601
United States

Phone: 617-562-5413 | Fax: 617-562-5415
View Map External Link
Primary Practice Address 736 CAMBRIDGE ST NICU
BRIGHTON, MA 02135-2907
United States

Phone: 617-789-2381 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363L00000X - Nurse Practitioner MA 190873