Healthcare Provider Details

I. General information

NPI: 1023433133
Provider Name (Legal Business Name): HEATHER ALISON HANNON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ALISON YOUNG RN MSN DNP AGN-NP

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 781-487-6212
  • Fax: 781-487-6201
Mailing address:
  • Phone: 781-487-6212
  • Fax: 781-487-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024173723
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number0001184428
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number207RC0000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: