Individual
AMANDA VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
55 FRUIT STREET CLN 115, MASS GENERAL HOSPITAL, BOSTON, MA 02114
(617) 724-8810
Mailing address
55 FRUIT ST MGH, CLINICS 115, BOSTON, MA 02114
(617) 724-8810
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
195282
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0357090
—
MA
01
—
NP2897
BCBS
MA
Enumeration date
09/12/2006
Last updated
07/08/2007
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