Healthcare Provider Details

I. General information

NPI: 1164074795
Provider Name (Legal Business Name): LORI MARCUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NEWBURY ST
DANVERS MA
01923-1027
US

IV. Provider business mailing address

50 JAY RD
NORTH ANDOVER MA
01845-5503
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-5504
  • Fax:
Mailing address:
  • Phone: 978-697-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2272505
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: