Healthcare Provider Details

I. General information

NPI: 1497972517
Provider Name (Legal Business Name): EMILY K PELOQUIN-PAPE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY K. PELOQUIN

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-2353
  • Fax:
Mailing address:
  • Phone: 857-364-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number273920
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN273920
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN273920
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number273920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: