Provider Demographics
NPI:1093745317
Name:NIELL, HEIDI BETH (PAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:BETH
Last Name:NIELL
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:D1B-30
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:D1B-30 DARA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-525-7624
Practice Address - Fax:617-278-6965
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant