Healthcare Provider Details

I. General information

NPI: 1245838390
Provider Name (Legal Business Name): SARAH LUPPINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST STE 6
BOSTON MA
02114-2783
US

IV. Provider business mailing address

5 DRUMLIN RD
IPSWICH MA
01938-2576
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-3380
  • Fax:
Mailing address:
  • Phone: 978-821-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number2292935
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2292935
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2292935
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: