MEDICARE: DR. MARY MARGARET ARUDA PHD, PNP, 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	RN145284	MA
2	363LP0200X	Pediatric Nurse Practitioner	RN145284	MA

General Provider Information

NPI Number	:	1770862088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MARGARET ARUDA PHD, PNP, FNP

Provider Business Mailing Address
First Line	:	100 MORRISSEY BLVD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02125-3393
Country	:	US
Telephone Number	:	617-287-5660
Fax Number	:	617-287-3977

Provider Business Practice Location Address
First Line	:	100 MORRISSEY BLVD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02125-3393
Country	:	US
Telephone Number	:	617-287-5660
Fax Number	:	617-287-3977

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

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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