Provider Demographics
NPI:1689643108
Name:SERINO, GILLIAN (NP)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:SERINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLARD STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-479-1452
Mailing Address - Fax:617-479-3500
Practice Address - Street 1:10 WILLARD STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-479-1452
Practice Address - Fax:617-479-3500
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ28751Medicare UPIN
MANP4813Medicare ID - Type Unspecified