Provider Demographics
NPI:1639338049
Name:SLICIS, DONNA MARIE (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:SLICIS
Suffix:
Gender:F
Credentials:APRN BC
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Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:MGH GCRC WHITE 13
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-1610
Mailing Address - Fax:617-124-3299
Practice Address - Street 1:45 HANCOCK ST
Practice Address - Street 2:APT 105
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1732
Practice Address - Country:US
Practice Address - Phone:617-471-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA156855363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075641OtherMGH