Provider Demographics
NPI:1699944041
Name:OSULLIVAN, MARY THERESA (RN REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:OSULLIVAN
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-7000
Mailing Address - Fax:617-754-0230
Practice Address - Street 1:230 BOWDOIN ST
Practice Address - Street 2:BOWDOIN ST HEALTH CENTER
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-754-0100
Practice Address - Fax:617-754-0230
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA191735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse