Healthcare Provider Details

I. General information

NPI: 1245371806
Provider Name (Legal Business Name): JUDITH MARIE PENTEDEMOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GROTON RD
AYER MA
01432-1168
US

IV. Provider business mailing address

200 GROTON RD
AYER MA
01432-1168
US

V. Phone/Fax

Practice location:
  • Phone: 978-784-9538
  • Fax: 978-784-9453
Mailing address:
  • Phone: 978-784-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number201948
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: