Healthcare Provider Details

I. General information

NPI: 1215711213
Provider Name (Legal Business Name): LISA THERESE QUARAGLIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAWRENCE ST
MEDFORD MA
02155-4136
US

IV. Provider business mailing address

100 LAWRENCE ST
MEDFORD MA
02155-4136
US

V. Phone/Fax

Practice location:
  • Phone: 781-864-5268
  • Fax:
Mailing address:
  • Phone: 781-864-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG06230264
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: