Provider Demographics
NPI:1205961497
Name:ISRAELIAN, AMY CATHERLENE (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHERLENE
Last Name:ISRAELIAN
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Gender:F
Credentials:APRN, BC
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:WACC, SUITE 435
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2000
Mailing Address - Fax:617-726-8089
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WACC, SUITE 435
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:617-726-8089
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-11-16
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Provider Licenses
StateLicense IDTaxonomies
MA252113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ40229Medicare UPIN