Healthcare Provider Details

I. General information

NPI: 1831604875
Provider Name (Legal Business Name): MS. SARA ANNE GEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

28 LASELL ST
WEST ROXBURY MA
02132-3705
US

V. Phone/Fax

Practice location:
  • Phone: 857-238-1011
  • Fax:
Mailing address:
  • Phone: 774-212-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number283014
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: