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General NPI Number Information
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NPI Number | 1336610062
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Entity Type | Individual
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Provider Name | NATALIA SULLIVAN VRAGOVIC FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-5491
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Country | US
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Telephone | 617-667-3394
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CALLA RD
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City | LONDONDERRY
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State | NH
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Zip | 03053-2389
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Country | US
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Telephone | 603-548-8806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | RN2274551
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License Number State | MA
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