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NPI Code Detail

MEDICARE: JOHANNA T MCDERMOTT NURSE PRACTITIONER

MEDICARE: JOHANNA T MCDERMOTT NURSE PRACTITIONER
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
1363LP0200XPediatric Nurse PractitionerRN254292MA
2363L00000XNurse PractitionerRN254292MA

General Provider Information

NPI Number : 1699101188
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHANNA T MCDERMOTT NURSE PRACTITIONER
Provider Business Mailing Address
First Line : PO BOX 415348
Second Line :
City : BOSTON
State : MA
Zip : 02241-5348
Country : US
Telephone Number : 800-225-8885
Fax Number : 508-334-1977
Provider Business Practice Location Address
First Line : 4 BROTHERTON WAY
Second Line :
City : AUBURN
State : MA
Zip : 01501-2684
Country : US
Telephone Number : 508-832-5917
Fax Number : 508-832-5751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2013
Last Update Date : 02/25/2026

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Directions to “ JOHANNA T MCDERMOTT NURSE PRACTITIONER” Practice Location

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