Healthcare Provider Details

I. General information

NPI: 1992867873
Provider Name (Legal Business Name): KRISTEN T PROVERB MSN RN NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MERRIMACK ST SUITE 300
LOWELL MA
01852
US

IV. Provider business mailing address

222 MERRIMACK ST SUITE 300
LOWELL MA
01852
US

V. Phone/Fax

Practice location:
  • Phone: 978-454-0706
  • Fax: 978-654-7978
Mailing address:
  • Phone: 978-454-0706
  • Fax: 978-654-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number258630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: