Provider Demographics
NPI:1144838384
Name:BAKOS, AMANDA ROSE (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:BAKOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 COURT RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2825
Mailing Address - Country:US
Mailing Address - Phone:781-858-1400
Mailing Address - Fax:617-207-9623
Practice Address - Street 1:218 MARION ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1758
Practice Address - Country:US
Practice Address - Phone:617-635-8372
Practice Address - Fax:617-535-8376
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA233859363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics