Healthcare Provider Details

I. General information

NPI: 1962252775
Provider Name (Legal Business Name): ANGEL NVIIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANGEL NVIIRI

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 05/11/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 STATE ST
FRAMINGHAM MA
01702-2463
US

IV. Provider business mailing address

131 STATE ST
FRAMINGHAM MA
01702-2463
US

V. Phone/Fax

Practice location:
  • Phone: 508-740-4727
  • Fax:
Mailing address:
  • Phone: 508-740-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2318448
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: