Healthcare Provider Details

I. General information

NPI: 1053905331
Provider Name (Legal Business Name): AGGIE J SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE STE 2
BOSTON MA
02120-2865
US

IV. Provider business mailing address

125 PARKER HILL AVE STE 2
BOSTON MA
02120-2865
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone: 617-754-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN63824
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2363775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: