Healthcare Provider Details

I. General information

NPI: 1134295991
Provider Name (Legal Business Name): CYNTHIA ROSE YEAGER RN, M.S., APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MARKET ST
LOWELL MA
01852-1805
US

IV. Provider business mailing address

261 MAIN ST
BOLTON MA
01740-1104
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-0389
  • Fax:
Mailing address:
  • Phone: 978-779-6453
  • Fax: 978-779-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number114104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: