Healthcare Provider Details

I. General information

NPI: 1669882593
Provider Name (Legal Business Name): DEBORAH DEANGELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HAVERHILL ST
LAWRENCE MA
01841-2884
US

IV. Provider business mailing address

34 HAVERHILL ST
LAWRENCE MA
01841-2884
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-3017
  • Fax: 978-685-4280
Mailing address:
  • Phone: 978-686-3017
  • Fax: 978-685-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2284879
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2284879
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: