Healthcare Provider Details

I. General information

NPI: 1578604401
Provider Name (Legal Business Name): GAEL A EVANGELISTA-UHL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST SUITE 404
BOSTON MA
02114-2783
US

IV. Provider business mailing address

73 SEARS RD
SOUTHBOROUGH MA
01772-1101
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2217
  • Fax: 617-724-3944
Mailing address:
  • Phone: 508-485-7788
  • Fax: 508-485-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number165083
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: