Provider Demographics
NPI:1295971737
Name:BOISSEAU, ANGELA SUZANNE (NNP/BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUZANNE
Last Name:BOISSEAU
Suffix:
Gender:F
Credentials:NNP/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2167
Mailing Address - Country:US
Mailing Address - Phone:508-735-7071
Mailing Address - Fax:
Practice Address - Street 1:3 BRUSSELS ST STE 302
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-3697
Practice Address - Country:US
Practice Address - Phone:508-735-7071
Practice Address - Fax:774-389-1696
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN228301363L00000X
CT004002363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care