Provider Demographics
NPI:1689732067
Name:ULLES, MONICA M (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:ULLES
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-5553
Mailing Address - Fax:617-730-0097
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:208
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-5553
Practice Address - Fax:617-730-0097
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0317225Medicaid
MA0317225Medicaid