Healthcare Provider Details

I. General information

NPI: 1023847571
Provider Name (Legal Business Name): MONICA ILVERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 NEWBURY ST
BOSTON MA
02115-2727
US

IV. Provider business mailing address

361 NEWBURY ST
BOSTON MA
02115-2727
US

V. Phone/Fax

Practice location:
  • Phone: 617-674-0356
  • Fax: 617-655-7741
Mailing address:
  • Phone: 617-674-0356
  • Fax: 617-401-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: