| NPI | 1144234055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN M HICKEY Provider Enrollment Manager 617-355-4956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 208000000X Pediatrics |
| 2088P0231X Urology, Pediatric Urology | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2026-08-19 |