Healthcare Provider Details

I. General information

NPI: 1194432658
Provider Name (Legal Business Name): DENISE FERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax: 781-598-8133
Mailing address:
  • Phone: 781-581-3900
  • Fax: 781-598-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2372892
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2372892
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: