Healthcare Provider Details

I. General information

NPI: 1083105860
Provider Name (Legal Business Name): DANIELLE HANNIGAN DIRECTOR OF NURSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAMIEN THORNTON DIR. OF OPERATIONS

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE 243
CHARLESTOWN MA
02129-1125
US

IV. Provider business mailing address

6 FRANKLIN ST UNIT 1
CHARLESTOWN MA
02129-3005
US

V. Phone/Fax

Practice location:
  • Phone: 617-870-1676
  • Fax: 617-412-3004
Mailing address:
  • Phone: 508-521-3080
  • Fax: 617-412-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number254108
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number254108
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number254108
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number254108
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number254108
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number254108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: