Healthcare Provider Details

I. General information

NPI: 1356756324
Provider Name (Legal Business Name): VALERIE LANTIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139
US

V. Phone/Fax

Practice location:
  • Phone: 781-350-8602
  • Fax:
Mailing address:
  • Phone: 781-350-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2284492
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: