Healthcare Provider Details

I. General information

NPI: 1164096822
Provider Name (Legal Business Name): VIRGINIA CAPPOTTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

22 BEACON ST
BEVERLY MA
01915-5610
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax: 781-598-9345
Mailing address:
  • Phone: 617-271-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2298954
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: