Healthcare Provider Details

I. General information

NPI: 1528791001
Provider Name (Legal Business Name): ONOME ESUTURIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 07/02/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LYNNWAY STE 112
LYNN MA
01901-1706
US

IV. Provider business mailing address

330 LYNNWAY STE 112
LYNN MA
01901-1706
US

V. Phone/Fax

Practice location:
  • Phone: 781-842-0613
  • Fax:
Mailing address:
  • Phone: 781-842-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2278078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: