Healthcare Provider Details

I. General information

NPI: 1649809765
Provider Name (Legal Business Name): AIMEE CAREW- LYONS RN, PNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST
BRIGHTON MA
02135-3602
US

IV. Provider business mailing address

30 WARREN ST
BRIGHTON MA
02135-3602
US

V. Phone/Fax

Practice location:
  • Phone: 617-779-1107
  • Fax: 617-779-1119
Mailing address:
  • Phone: 617-779-1107
  • Fax: 617-779-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number186062
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: