Provider Demographics
NPI:1912695149
Name:LANDRY, VIOLET (FNP)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 CONGRESS ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1877
Mailing Address - Country:US
Mailing Address - Phone:781-686-7331
Mailing Address - Fax:
Practice Address - Street 1:300 NEEDHAM ST STE 1B
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1572
Practice Address - Country:US
Practice Address - Phone:617-903-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily