Healthcare Provider Details

I. General information

NPI: 1093800583
Provider Name (Legal Business Name): MICHELLE JEAN CISZEWSKI MS, APRN-BC, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE STREET SUITE 529
BOSTON MA
02130
US

IV. Provider business mailing address

59 OAK AVENUE
NORTHBOROUGH MA
01532
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-4615
  • Fax: 617-983-4735
Mailing address:
  • Phone: 508-936-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number236867
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number236867
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: