Individual
MRS. LISA DUMOUCHEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
330 BROOKLINE AVE, FA 813, BOSTON, MA 02215-5400
(617) 632-9880
(617) 632-9890
Mailing address
330 BROOKLINE AVE, FA 813, BOSTON, MA 02215-5400
(617) 632-9880
(617) 632-9890
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
203471
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0706973
—
MA
01
—
NP5150
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/18/2006
Last updated
05/30/2014
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