Provider Demographics
NPI:1861685976
Name:RAMAKRISHNAN, LAURYL (NP)
Entity Type:Individual
Prefix:
First Name:LAURYL
Middle Name:
Last Name:RAMAKRISHNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURYL
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
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 1:840 HARRISON AVE
Practice Address - Street 2:MENINO 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4363
Practice Address - Fax:617-414-3999
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267716363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110096210AMedicaid
MA001010702Medicare PIN