Healthcare Provider Details

I. General information

NPI: 1366884777
Provider Name (Legal Business Name): ALLYN ANDERSON STREETER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SPRING ST
MARION MA
02738-1518
US

IV. Provider business mailing address

66 SPRING ST
MARION MA
02738-1518
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-2000
  • Fax: 508-291-8368
Mailing address:
  • Phone: 508-748-2000
  • Fax: 508-291-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN255078
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN255078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: