Provider Demographics
NPI:1578267548
Name:SOWELL, HEATHER LYNN MORIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN MORIN
Last Name:SOWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 CONSTITUTION RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2008
Mailing Address - Country:US
Mailing Address - Phone:203-803-7237
Mailing Address - Fax:
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2292
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily