Healthcare Provider Details

I. General information

NPI: 1124571310
Provider Name (Legal Business Name): CORINNE CLANCY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE CATALANO

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE HOSPITALIST SERVICE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE HOSPITALIST SERVICE
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2299383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: