Provider Demographics
NPI:1124544515
Name:POILLUCCI, MARY (RNNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:POILLUCCI
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6327
Mailing Address - Country:US
Mailing Address - Phone:508-875-4811
Mailing Address - Fax:508-875-5942
Practice Address - Street 1:99 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6327
Practice Address - Country:US
Practice Address - Phone:508-875-4811
Practice Address - Fax:508-875-5942
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily