Provider Demographics
NPI:1457466914
Name:PAULL, NANCY C (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:PAULL
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-638-7350
Practice Address - Fax:617-638-7288
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA147000363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400251713Medicare PIN
MAQ56915Medicare UPIN