Healthcare Provider Details

I. General information

NPI: 1639465602
Provider Name (Legal Business Name): LEE REGIONAL VISITING NURSE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PARK ST
LEE MA
01238-1717
US

IV. Provider business mailing address

32 PARK ST
LEE MA
01238-1717
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-1212
  • Fax: 413-243-4215
Mailing address:
  • Phone: 413-243-1212
  • Fax: 413-243-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY ANN CHAFFEE
Title or Position: CEO
Credential: RN,MSN
Phone: 413-243-1212