Provider Demographics
NPI:1952380891
Name:CORMIER, AURELIE CATHERINE (NP)
Entity Type:Individual
Prefix:MS
First Name:AURELIE
Middle Name:CATHERINE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4043
Mailing Address - Country:US
Mailing Address - Phone:617-417-8482
Mailing Address - Fax:
Practice Address - Street 1:72 FALCON ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-4043
Practice Address - Country:US
Practice Address - Phone:617-417-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN143304363LA2200X
MA143304364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP5075Medicare ID - Type Unspecified