Healthcare Provider Details

I. General information

NPI: 1568494607
Provider Name (Legal Business Name): THERESE M HANLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/21/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

10 WILLARD ST
QUINCY MA
02169-1281
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-5130
  • Fax:
Mailing address:
  • Phone: 617-479-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number257944
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: