MEDICARE: ALLYN ANDERSON STREETER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN255078	MA
2	363LS0200X	School Nurse Practitioner	RN255078	MA

General Provider Information

NPI Number	:	1366884777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYN ANDERSON STREETER FNP

Provider Business Mailing Address
First Line	:	66 SPRING ST
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1518
Country	:	US
Telephone Number	:	508-748-2000
Fax Number	:	508-291-8368

Provider Business Practice Location Address
First Line	:	66 SPRING ST
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1518
Country	:	US
Telephone Number	:	508-748-2000
Fax Number	:	508-291-8368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2013
Last Update Date	:	07/26/2013

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