Healthcare Provider Details

I. General information

NPI: 1386843118
Provider Name (Legal Business Name): MARYELLEN COTTER RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6131
  • Fax: 617-975-0808
Mailing address:
  • Phone: 617-732-6131
  • Fax: 617-975-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number181395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: