MICHELLE J BOULEY (NPI# 1871910364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871910364 |
| Entity Type | Individual |
| Full Name | MICHELLE J BOULEY |
| Other Name | MICHELLE J GRAVALLESE |
| Credential | PA-C |
| Practice Address |
1 Orthopedics Dr 2nd Floor Peabody MA 01960-1668 |
| Practice Telephone | 9788186350 |
| Practice Fax Number | 9788544811 |
| Mailing Telephone | 9788186350 |
| Mailing Fax Number | 9788544811 |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2017-09-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA4987 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1 ORTHOPEDICS DR 2ND FLOOR |
| City | PEABODY |
| State | MA |
| Zip Code | 01960-1668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104804673 | Jarett S Landman | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2006-01-05 |
| 1285101329 | Jordan M Evans | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2018-10-26 |
| 1740793561 | Sports Medicine North Orthopaedic Surgery, Inc | Radiology | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2017-11-15 |
| 1821535378 | North Shore Ambulatory Anesthesia Partners LLC | Anesthesiology | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2017-01-23 |
| 1265983761 | Sports Medicine North Orthopedic Surgery, Inc. | Orthopaedic Surgery | 1 Orthopedics Dr, 2nd Floor, Peabody, MA 01960-1668 | 2016-10-19 |
| 1548653801 | Edward O'reilly | Physician Assistant | 1 Orthopedics Dr, 2nd Floor, Peabody, MA 01960-1668 | 2015-03-11 |
| 1699171470 | Sports Medicine North Orthopaedic Surgery, Inc. | Specialist | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2014-11-06 |
| 1528468121 | Kyle Williams | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2014-09-02 |
| 1912315722 | Allison Shawcross | Physical Therapist | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2014-07-24 |
| 1952742975 | Jared Polansky | Physician Assistant | 1 Orthopedics Dr, 2nd Floor, Peabody, MA 01960-1668 | 2013-07-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020321 | Kathleen Marie Cliffe | Nurse Practitioner | 15 Sandra Rd, Peabody, MA 01960 | 2020-07-10 |
| 1801398102 | Janis Melanson | Counselor | Higgins Middle School, 85 Perkins Street, Peabody, MA 01960 | 2018-03-02 |
| 1679082036 | Kelsey Ann Lima | Social Worker | 9 Centennial Drive, Suite 202, Peabody, MA 01960 | 2017-09-28 |
| 1609394485 | Victoria Jade Olechowski | Specialist/Technologist | 1002 Crane Brook Way, Peabody, MA 01960 | 2017-08-31 |
| 1841715711 | Alexandra Lee Chasse | Counselor | 9 Cenntenial Drive, Suit 202, Peabody, MA 01960 | 2017-08-11 |
| 1275982936 | Miguel A Roque | Dentist | 6 Essex Center Drive Suite 110, Peabody, MA 01960 | 2016-06-03 |
| 1528412061 | Kabamedicalcorporation | Durable Medical Equipment & Medical Supplies | 484lowell Street, Peabody, MA 01960 | 2016-04-21 |
| 1437510815 | Ana Tereza T. Wescott | Dentist | 89 Foster Street, Peabody Family Health Center, Peabody, MA 01960 | 2016-03-14 |
| 1225496474 | Ashley Motta | Counselor | 24 Jennifer Lane, Peabody, MA 01960 | 2016-02-03 |
| 1578942645 | Cerebral Palsy of Eastern Mass Incorporated | Early Intervention Provider Agency | 6 Stratis Way, Peabody, MA 01960 | 2015-05-22 |
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| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104804673 | Jarett S Landman | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2006-01-05 |
| 1285101329 | Jordan M Evans | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2018-10-26 |
| 1760721146 | Benjamin Lynn Smith | Physician Assistant | 1 Orthopedics Dr, Peabody, MA 01960-1668 | 2013-02-05 |
| 1265518237 | Christine Ann Sclafani | Physician Assistant | 1 Orthopedics Dr, 2nd Floor, Peabody, MA 01960-1668 | 2006-10-31 |
| 1740391333 | Wendy Lok Hyatt | Physician Assistant | 1 Essex Center Drive, Lahey Northshore, Peabody, MA 01960-2901 | 2006-08-31 |
| 1912985490 | Raymond Feeley | Physician Assistant | 1 Orthopedic Dr, Peabody, MA 01960-1668 | 2006-01-05 |
| 1538147012 | Michael D Ierardi | Physician Assistant | 1 Orthopedic Dr, 2nd Floor, Peabody, MA 01960-1668 | 2006-01-05 |
| 1669450144 | Kelsi Sullivan | Physician Assistant | 1 Orthopedic Dr, Peabody, MA 01960-1668 | 2006-01-05 |
| 1508844077 | Christopher P. Stanton | Physician Assistant | 1 Orthopedic Dr, Peabody, MA 01960-1668 | 2006-01-05 |
| 1386622850 | Kimberly Dowling | Physician Assistant | 1 Orthopedics Dr, 2nd Floor, Peabody, MA 01960-1668 | 2006-01-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.