Healthcare Provider Details

I. General information

NPI: 1740184993
Provider Name (Legal Business Name): CENTROMED HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST STE G01
LAWRENCE MA
01840-1919
US

IV. Provider business mailing address

15 UNION ST STE G01
LAWRENCE MA
01840-1919
US

V. Phone/Fax

Practice location:
  • Phone: 978-852-5478
  • Fax: 866-571-7088
Mailing address:
  • Phone: 978-852-5478
  • Fax: 866-571-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: FANTASIA HUGHES
Title or Position: OWNER
Credential:
Phone: 978-852-5478