=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417496555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL LESSER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2017
-----------------------------------------------------
Last Update Date | 02/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 EVANS RD
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-877-9064
-----------------------------------------------------
Fax | 781-434-6447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 SECOND AVE BOSTON IVF
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-877-9064
-----------------------------------------------------
Fax | 781-434-6447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 139034
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------