Healthcare Provider Details

I. General information

NPI: 1114895711
Provider Name (Legal Business Name): GINA ELISABETTA OUELLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ORNAC
CONCORD MA
01742-4159
US

IV. Provider business mailing address

18 SUNSET RD
DRACUT MA
01826-2440
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberRN2325436
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: