Healthcare Provider Details

I. General information

NPI: 1720716681
Provider Name (Legal Business Name): NOELLE GRACE EFANTIS DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONVERSE ST STE 200
LONGMEADOW MA
01106-1760
US

IV. Provider business mailing address

353 BENNETT RD
HAMPDEN MA
01036-9103
US

V. Phone/Fax

Practice location:
  • Phone: 413-374-0031
  • Fax:
Mailing address:
  • Phone: 860-709-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2302800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: