Healthcare Provider Details

I. General information

NPI: 1831644129
Provider Name (Legal Business Name): FARIYDA MULRAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WORCESTER ST
SPRINGFIELD MA
01151-1045
US

IV. Provider business mailing address

77 FOWLER ST
DORCHESTER MA
02121-3714
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-6820
  • Fax:
Mailing address:
  • Phone: 617-306-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06162456
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: