Healthcare Provider Details

I. General information

NPI: 1376579615
Provider Name (Legal Business Name): MARGARET P RUDD ARIETA APRN, PPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OTIS ST
MANSFIELD MA
02048-2054
US

IV. Provider business mailing address

120 OTIS ST
MANSFIELD MA
02048-2054
US

V. Phone/Fax

Practice location:
  • Phone: 508-572-9939
  • Fax:
Mailing address:
  • Phone: 508-572-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number169769
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number169769
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number164764
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: