Healthcare Provider Details

I. General information

NPI: 1235640681
Provider Name (Legal Business Name): CAROLYN CIPOLLA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN HENRY

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEBSTER ST
HANOVER MA
02339-1227
US

IV. Provider business mailing address

42 COMMON ST
QUINCY MA
02169-1610
US

V. Phone/Fax

Practice location:
  • Phone: 781-754-6545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2284663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: