Healthcare Provider Details

I. General information

NPI: 1891833935
Provider Name (Legal Business Name): MARIA S. KOEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL
BOSTON MA
02215-5306
US

IV. Provider business mailing address

33 AUBURN ST # B
WALTHAM MA
02453-2803
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2699
  • Fax:
Mailing address:
  • Phone: 781-771-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: