Healthcare Provider Details

I. General information

NPI: 1073363172
Provider Name (Legal Business Name): SARAH GRACE YANULIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LOWELL ST STE 302
ANDOVER MA
01810-4659
US

IV. Provider business mailing address

142 FOREST ST
DUXBURY MA
02332-2954
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-2731
  • Fax:
Mailing address:
  • Phone: 781-405-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2341436
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN2341436
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: