Healthcare Provider Details

I. General information

NPI: 1649523523
Provider Name (Legal Business Name): LISA MARIE RULLIE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 WORCESTER RD STE 203
FRAMINGHAM MA
01701-5410
US

IV. Provider business mailing address

1881 WORCESTER RD STE 203
FRAMINGHAM MA
01701-5410
US

V. Phone/Fax

Practice location:
  • Phone: 508-834-3183
  • Fax: 508-532-1168
Mailing address:
  • Phone: 508-834-3183
  • Fax: 508-532-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019042883
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number2019042883
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number2019042883
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: