Basic Information
| Provider Information | |||||||||
| NPI: | 1780101543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSGOOD | ||||||||
| FirstName: | WILLOW | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ALBANY ST FL GROUND | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178925274 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | JEREMIAH BURKE HIGH SCHOOL / DEARBORN STEM ACADEMY | ||||||||
| Address2: | 60 WASHINGTON STREET | ||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175349954 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LS0200X | RN2310401 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | School | 363LF0000X | RN2310401 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.