Healthcare Provider Details

I. General information

NPI: 1477142842
Provider Name (Legal Business Name): DEBRA COVIELLO COOK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MAIN ST
HAVERHILL MA
01830-5046
US

IV. Provider business mailing address

34 CHARLES ST
GEORGETOWN MA
01833-1110
US

V. Phone/Fax

Practice location:
  • Phone: 978-374-0719
  • Fax:
Mailing address:
  • Phone: 978-790-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2302009
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: