Provider Demographics
NPI:1144922717
Name:POURER, VLADIMIR (FNP-C)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:POURER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4940
Mailing Address - Country:US
Mailing Address - Phone:617-750-7885
Mailing Address - Fax:
Practice Address - Street 1:200 BOSTON PROVIDENCE HWY #203
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-326-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260820363LF0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily