Healthcare Provider Details

I. General information

NPI: 1316610900
Provider Name (Legal Business Name): DARLINE JUSTAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2.
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2327588
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2327588
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: