Healthcare Provider Details

I. General information

NPI: 1275357311
Provider Name (Legal Business Name): ISABELLA MARIANO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BOSTON POST RD STE 4C
SUDBURY MA
01776-3022
US

IV. Provider business mailing address

323 BOSTON POST RD STE 4C
SUDBURY MA
01776-3022
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-6960
  • Fax: 978-443-6502
Mailing address:
  • Phone: 978-443-6960
  • Fax: 978-443-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ISABELLA BAUTERS
Title or Position: NP/OWNER
Credential: PMHNP-BC
Phone: 978-443-6960