Healthcare Provider Details

I. General information

NPI: 1760634943
Provider Name (Legal Business Name): KATELYN SCAGNELLI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2008
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COURTHOUSE LN SUITE 9
CHELMSFORD MA
01824-1728
US

IV. Provider business mailing address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-8400
  • Fax:
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number274092
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number074634-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: