Provider Demographics
NPI:1720307101
Name:IRISH, EILEEN (FNP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:IRISH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AVERY ST UNIT 407
Mailing Address - Street 2:UNIT #407
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1036
Mailing Address - Country:US
Mailing Address - Phone:617-306-0815
Mailing Address - Fax:
Practice Address - Street 1:3 AVERY ST UNIT 407
Practice Address - Street 2:UNIT #407
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1036
Practice Address - Country:US
Practice Address - Phone:617-306-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN169935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily