Healthcare Provider Details

I. General information

NPI: 1184424012
Provider Name (Legal Business Name): NOPPORN THANGTHAENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CONIFER HILL DR
DANVERS MA
01923-1193
US

IV. Provider business mailing address

147 S MAIN ST
MIDDLETON MA
01949-2446
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-2555
  • Fax:
Mailing address:
  • Phone: 978-774-2555
  • Fax: 978-774-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2330371
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: