Healthcare Provider Details

I. General information

NPI: 1477534105
Provider Name (Legal Business Name): KARIN L CUNNIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 COLUMBIAN ST SUITE 100
S WEYMOUTH MA
02190-1138
US

IV. Provider business mailing address

549 COLUMBIAN ST SUITE 100
S WEYMOUTH MA
02190-1138
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-5680
  • Fax: 781-337-3275
Mailing address:
  • Phone: 781-337-5680
  • Fax: 781-337-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number181421
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: