Healthcare Provider Details

I. General information

NPI: 1588119697
Provider Name (Legal Business Name): CODY AURORA DESOUZA FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WINTER ST
WESTON MA
02493-2611
US

IV. Provider business mailing address

28 QUEENSBERRY ST APT 15
BOSTON MA
02215-5258
US

V. Phone/Fax

Practice location:
  • Phone: 508-655-8118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2299548
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2299548
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: