Healthcare Provider Details

I. General information

NPI: 1366954729
Provider Name (Legal Business Name): MARY ELLEN PUOPOLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68A MAIN ST STE 103
MEDWAY MA
02053-1775
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-321-2845
  • Fax: 508-321-2848
Mailing address:
  • Phone: 508-473-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN278211
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN278211
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: