Healthcare Provider Details

I. General information

NPI: 1932362613
Provider Name (Legal Business Name): NORTH SHORE NURSE PRACTITIONER ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CONSTITUTION LN SUITE 300A
DANVERS MA
01923-3694
US

IV. Provider business mailing address

85 CONSTITUTION LN SUITE 300A
DANVERS MA
01923-3694
US

V. Phone/Fax

Practice location:
  • Phone: 978-750-0755
  • Fax: 978-750-0766
Mailing address:
  • Phone: 978-750-0755
  • Fax: 978-750-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125049
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number201757
License Number StateMA

VIII. Authorized Official

Name: CHRISTINE DALE RAUCCI
Title or Position: OWNER / PARTNER
Credential: APRN
Phone: 978-750-0755