Healthcare Provider Details

I. General information

NPI: 1710755301
Provider Name (Legal Business Name): ALLISON KULAS RODGERS DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

215 HARVARD ST UNIT 10
MEDFORD MA
02155-6258
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-2900
  • Fax:
Mailing address:
  • Phone: 860-803-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2316475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: