Healthcare Provider Details

I. General information

NPI: 1912994195
Provider Name (Legal Business Name): GENEVIEVE B SLOBODA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST
ACTON MA
01720-3718
US

IV. Provider business mailing address

321 MAIN ST
ACTON MA
01720-3718
US

V. Phone/Fax

Practice location:
  • Phone: 978-635-8700
  • Fax: 978-635-8920
Mailing address:
  • Phone: 978-635-8700
  • Fax: 978-635-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: