Unknown Individual – Adult Health Nurse Practitioner, NPI 1104033919

Unknown Individual is a healthcare provider. based in Boston, Massachusetts. specializing in Adult Health Nurse Practitioner. They hold a License No. RN86395-NP (MA). The NPI Number for Unknown Individual is 1104033919

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104033919
Phone
(617) 636-1625
Address
750 WASHINGTON ST # 235
Deactivation Date
14 August 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 750 WASHINGTON ST # 235

    NEW ENGLAND MEDICAL CENTER

    BOSTON, MA 021111526

    Phone: (617) 636-1625

    Fax: (617) 636-9712

    Type: Location

  • 163, Beech Street, Bellevue, Roslindale, Boston, Suffolk County, Massachusetts, 02132, United States

    ROSLINDALE, MA 021312714

    Phone: (617) 327-8239

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02111)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1104033919.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Boston, Massachusetts in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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