Healthcare Provider Details

I. General information

NPI: 1255476735
Provider Name (Legal Business Name): CONSTANCE ANNE ROCHE RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WANG SUITE 240
BOSTON MA
02114-2621
US

IV. Provider business mailing address

17 BELKNAP ST
CONCORD MA
01742-2401
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-9200
  • Fax: 617-726-9210
Mailing address:
  • Phone: 617-726-9200
  • Fax: 617-726-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number115238
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number115238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: