MEDICARE: EILEEN C DEWITT NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0005X	Critical Care Neonatal Nurse Practitioner	182507	MA

General Provider Information

NPI Number	:	1093976854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN C DEWITT NNP

Provider Business Mailing Address
First Line	:	300 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-8076
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-8076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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