Healthcare Provider Details

I. General information

NPI: 1639862329
Provider Name (Legal Business Name): LAUREN KATIE FUSEK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

IV. Provider business mailing address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0940
  • Fax: 617-770-0526
Mailing address:
  • Phone: 617-774-0940
  • Fax: 617-770-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84552
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2358425
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: