Provider Demographics
NPI:1861702151
Name:EGAN, AMY LYNN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:EGAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:CEBULSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:857-238-1300
Mailing Address - Fax:857-238-1301
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:857-238-1300
Practice Address - Fax:857-238-1301
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health