Healthcare Provider Details

I. General information

NPI: 1659824209
Provider Name (Legal Business Name): TAYLOR CHRISTINE PUDDISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WARD HILL AVE
HAVERHILL MA
01835-6928
US

IV. Provider business mailing address

50 DOLPHIN RD
NEWTON MA
02459-1305
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-8000
  • Fax:
Mailing address:
  • Phone: 617-290-4245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number068379-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2288813
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number068379-23
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2288813
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2288813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: