Healthcare Provider Details

I. General information

NPI: 1043418882
Provider Name (Legal Business Name): UNIVERSITY OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 OLD WESTPORT ROAD UMASS DARTMOUTH STUDENT HEALTH SERVICES
NORTH DARTMOUTH MA
02747-2300
US

IV. Provider business mailing address

285 OLD WESTPORT ROAD UMASS DARTMOUTH STUDENT HEALTH SERVICES
NORTH DARTMOUTH MA
02747-2300
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-8982
  • Fax: 508-999-8985
Mailing address:
  • Phone: 508-999-8982
  • Fax: 508-999-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIANNE SULLIVAN
Title or Position: DIRECTOR OF STUDENT HEALTH SERVICES
Credential: DNP, ANP-BC
Phone: 508-999-8984