Provider Demographics
NPI:1245464809
Name:WILLMOTT, LINDA M (ANP-BC, COHN-S)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:WILLMOTT
Suffix:
Gender:F
Credentials:ANP-BC, COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-4628
Mailing Address - Fax:617-983-4656
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-4628
Practice Address - Fax:617-983-4656
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA108959364SA2200X, 364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health