Healthcare Provider Details

I. General information

NPI: 1104845692
Provider Name (Legal Business Name): LINDA ZACCAGNINI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

26 MEADOWVIEW RD
WAYLAND MA
01778-2929
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7422
  • Fax: 617-355-0302
Mailing address:
  • Phone: 508-788-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number143090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: