Provider Demographics
NPI:1417171752
Name:AMGOTT, RACHEL S (RN MSN CPNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:AMGOTT
Suffix:
Gender:F
Credentials:RN MSN CPNP
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Mailing Address - Street 1:BMC PROVIDER ENROLLMENT OFFICE
Mailing Address - Street 2:960 MASSACHUSETTS AVE., 2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE.
Practice Address - Street 2:CROSSTOWN BLDG FL 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-4841
Practice Address - Fax:617-414-4541
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
MARN/NP232192363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINPP37498OtherLICENSE