Healthcare Provider Details

I. General information

NPI: 1063106086
Provider Name (Legal Business Name): SARAH FAWCETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ARSENAL ST
WATERTOWN MA
02472-5091
US

IV. Provider business mailing address

485 ARSENAL ST
WATERTOWN MA
02472-5091
US

V. Phone/Fax

Practice location:
  • Phone: 617-972-5100
  • Fax:
Mailing address:
  • Phone: 617-972-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2368550
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: