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General NPI Number Information
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NPI Number | 1689183014
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Entity Type | Individual
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Provider Name | KRISTY POULLIOT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 29 HUDSON RD STE 3310
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City | SUDBURY
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State | MA
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Zip | 01776-1753
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Country | US
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Telephone | 978-443-8810
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Fax | 978-443-8839
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Provider Business Mailing Address
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Address Line | 171 MAIN ST STE 203B
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City | ASHLAND
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State | MA
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Zip | 01721-1187
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Country | US
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Telephone | 508-881-3029
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Fax | 508-881-1752
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2268086
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7330
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2268086
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License Number State | MA
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