Healthcare Provider Details

I. General information

NPI: 1366250755
Provider Name (Legal Business Name): LI QI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WASHINGTON ST
HUDSON MA
01749-3735
US

IV. Provider business mailing address

234 WASHINGTON ST HUDSON, MASSACHUSETTS 17493735
HUDSON MA
01749-3735
US

V. Phone/Fax

Practice location:
  • Phone: 978-562-2663
  • Fax:
Mailing address:
  • Phone: 978-562-2663
  • Fax: 978-562-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number074506-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2312133
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: