Provider Demographics
NPI:1295482248
Name:BEAUCIQUOT, FABIOLA BOUSSEAU
Entity type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:BOUSSEAU
Last Name:BEAUCIQUOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:
Other - Last Name:BOUSSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 WILLARD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1545
Mailing Address - Country:US
Mailing Address - Phone:617-275-9216
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1571
Practice Address - Country:US
Practice Address - Phone:781-768-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283669163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty