Provider Demographics
NPI:1063551620
Name:DELVECCHIO, PAMELA ANN (REGISTERED NURSE NP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:REGISTERED NURSE NP
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:DIMILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-244-3600
Mailing Address - Fax:617-721-4888
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4360
Practice Address - Fax:617-724-4888
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN180054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner