Healthcare Provider Details

I. General information

NPI: 1386721868
Provider Name (Legal Business Name): ERIKA MENEELY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET ELL 14
BOSTON MA
02114
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIANS ORGANIZATION INC
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-5432
  • Fax:
Mailing address:
  • Phone: 617-724-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number211900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: