Provider Demographics
NPI:1063755569
Name:GATELY, ANNE HARTE (RN, MSN, C-PNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:HARTE
Last Name:GATELY
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Gender:F
Credentials:RN, MSN, C-PNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 CAMBRIDGE STREET, STE 400
Mailing Address - Street 2:MGH SPORTS MEDICINE CLINIC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 CAMBRIDGE ST STE 400
Practice Address - Street 2:MGH YOUTH SPORTS CONCUSSION CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2797
Practice Address - Country:US
Practice Address - Phone:617-724-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA20130452363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics