Healthcare Provider Details

I. General information

NPI: 1649532391
Provider Name (Legal Business Name): CIERA JOYCE MAFFEI CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ROUTE 130
FORESTDALE MA
02644-0549
US

IV. Provider business mailing address

P O BOX 549
FORESTDALE MA
02644-0549
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-5306
  • Fax: 508-477-0297
Mailing address:
  • Phone: 508-477-5306
  • Fax: 508-477-0297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241970
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number241970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: