Individual
JOELLE GRACE SULISTIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
732 HARRISON AVE, FL 2, PRESTON BLDG, BOSTON, MA 02118-2309
(617) 638-7470
(617) 638-7449
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN2330392
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110164332A
—
MA
05
—
3136892
—
NH
Enumeration date
06/08/2020
Last updated
04/10/2024
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