Provider Demographics
NPI:1427161454
Name:SLATTERY, MEGHAN J (ARNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:J
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2037
Mailing Address - Country:US
Mailing Address - Phone:917-439-0580
Mailing Address - Fax:617-726-8528
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BUL 457B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-0267
Practice Address - Fax:617-726-8528
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526340363LF0000X
NYF334992-1363LF0000X
MARN266125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily