Individual
STACY JILL OSTERHOUDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNPC-AG,
Contact information
Practice address
725 ALBANY STREET, SUITE 7B, SHAPIRO BLDG., BOSTON, MA 02118
(617) 638-8456
(617) 638-8465
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
RN2389809
MA
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
RN2389809
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110204587A
—
MA
05
—
3143868
—
NH
Enumeration date
05/17/2023
Last updated
09/18/2024
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