Healthcare Provider Details

I. General information

NPI: 1548577281
Provider Name (Legal Business Name): BETH MARIE SPERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 NONOTUCK ST
FLORENCE MA
01062-2657
US

IV. Provider business mailing address

PO BOX 708
GOSHEN MA
01032-0708
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-2016
  • Fax:
Mailing address:
  • Phone: 413-268-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number198816
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: