Healthcare Provider Details

I. General information

NPI: 1154994499
Provider Name (Legal Business Name): CHRISTOPHER DAVID ESTES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON 5TH FL
BOSTON MA
02118-2365
US

IV. Provider business mailing address

801 ALBANY STREET FL GROUND
BOSTON MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-6840
  • Fax: 617-414-6710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2309492
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2309492
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: