Healthcare Provider Details

I. General information

NPI: 1013201177
Provider Name (Legal Business Name): TANYA ANN COUTU FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST STE 108
LOWELL MA
01852-1300
US

IV. Provider business mailing address

33 BARTLETT ST STE 108
LOWELL MA
01852-1300
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-1811
  • Fax: 978-452-9111
Mailing address:
  • Phone: 978-453-1811
  • Fax: 978-452-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN255877
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: