Healthcare Provider Details

I. General information

NPI: 1578600524
Provider Name (Legal Business Name): ALLYSSA LYNNE HARRIS RNC,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 WARREN ST
ROXBURY MA
02119-1833
US

IV. Provider business mailing address

21 MITCHELL GRANT WAY
BEDFORD MA
01730-1227
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-7400
  • Fax:
Mailing address:
  • Phone: 617-442-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number174490
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: