Healthcare Provider Details

I. General information

NPI: 1336610062
Provider Name (Legal Business Name): NATALIA SULLIVAN VRAGOVIC FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIA ANN SULLIVAN

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

6 CALLA RD
LONDONDERRY NH
03053-2389
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3394
  • Fax:
Mailing address:
  • Phone: 603-548-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN2274551
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: