Provider Demographics
NPI:1366492662
Name:GIANAN, MARIA EDEN AGUILAR (NP)
Entity Type:Individual
Prefix:MISS
First Name:MARIA EDEN
Middle Name:AGUILAR
Last Name:GIANAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:EDEN
Other - Middle Name:AGUILAR
Other - Last Name:GIANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:515 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6811
Mailing Address - Country:US
Mailing Address - Phone:781-724-7348
Mailing Address - Fax:781-329-0306
Practice Address - Street 1:24 WALDO ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-724-7348
Practice Address - Fax:781-329-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175294363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0367Medicare ID - Type Unspecified
MAR84296Medicare UPIN