Provider Demographics
NPI:1750085155
Name:STARR, ARIELLE EBANIETTI (NP)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:EBANIETTI
Last Name:STARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ARIELLE
Other - Middle Name:BROOKE
Other - Last Name:EBANIETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:124 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2322
Mailing Address - Country:US
Mailing Address - Phone:201-925-9889
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2330669363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics