Provider Demographics
NPI:1154884120
Name:PUTNAM, MARLENE (FNP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE, 3RD FLOOR WEST
Practice Address - Street 2:PRESTON BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-7350
Practice Address - Fax:617-638-7228
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN263262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3138583Medicaid
MA110159074AMedicaid