Healthcare Provider Details

I. General information

NPI: 1235196759
Provider Name (Legal Business Name): EMILY B REULET NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 WASHINGTON ST BABSON PROFESSIONAL BUILDING
GLOUCESTER MA
01930-4832
US

IV. Provider business mailing address

298 WASHINGTON ST BABSON PROFESSIONAL BUILDING
GLOUCESTER MA
01930-4832
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-5079
  • Fax:
Mailing address:
  • Phone: 978-283-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number252377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: