Healthcare Provider Details

I. General information

NPI: 1801156658
Provider Name (Legal Business Name): MICHELLE ANN RICUPERO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HANOVER ST
BOSTON MA
02113-1901
US

IV. Provider business mailing address

10 BLUE SKY DR
HINGHAM MA
02043-3007
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN260936
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN260936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: