Healthcare Provider Details

I. General information

NPI: 1063984540
Provider Name (Legal Business Name): CHRISTINE ELIZABETH MANSEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NEW LANCASTER RD
LEOMINSTER MA
01453-4958
US

IV. Provider business mailing address

5 NEPOSNET ST ATTN:MEDICAL STAFF SERVICES
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-3208
  • Fax: 978-840-1680
Mailing address:
  • Phone: 508-852-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: