Healthcare Provider Details

I. General information

NPI: 1730689217
Provider Name (Legal Business Name): LAURA BURAK MODERI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

22 PARSONS AVE
LYNNFIELD MA
01940-1822
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN2272427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: