Healthcare Provider Details

I. General information

NPI: 1770072258
Provider Name (Legal Business Name): GILLIAN BERNSTEIN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DIMOCK ST
BOSTON MA
02119-1208
US

IV. Provider business mailing address

45 DIMOCK ST
ROXBURY MA
02119-1208
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-8800
  • Fax: 617-442-5840
Mailing address:
  • Phone: 617-442-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2289034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: