Provider Demographics
NPI:1114598547
Name:KEAVENEY, GABRIELLE M (NP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:M
Last Name:KEAVENEY
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Gender:F
Credentials:NP
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVENUE, 3RD FL
Practice Address - Street 2:MOAKLEY BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-6428
Practice Address - Fax:617-638-5756
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2023-12-04
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Provider Licenses
StateLicense IDTaxonomies
MA2284048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner