Healthcare Provider Details

I. General information

NPI: 1437284924
Provider Name (Legal Business Name): RACHEL J COPERTINO MSN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE #1
BOSTON MA
02215-5400
US

IV. Provider business mailing address

18 KINGS GRANT RD
WESTBOROUGH MA
01581-1815
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-4042
  • Fax:
Mailing address:
  • Phone: 508-561-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number259828
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN259828
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: