Healthcare Provider Details

I. General information

NPI: 1578267548
Provider Name (Legal Business Name): HEATHER LYNN MORIN SOWELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LYNN MORIN

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACKBURN DR
GLOUCESTER MA
01930-2292
US

IV. Provider business mailing address

28 CONSTITUTION RD
CHARLESTOWN MA
02129-2008
US

V. Phone/Fax

Practice location:
  • Phone: 978-281-1500
  • Fax:
Mailing address:
  • Phone: 203-803-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2349476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: