Healthcare Provider Details

I. General information

NPI: 1174792345
Provider Name (Legal Business Name): ANDREA DEMARS RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MYSTIC AVE
MEDFORD MA
02155-4632
US

IV. Provider business mailing address

151 MYSTIC AVE
MEDFORD MA
02155-4632
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-1199
  • Fax: 781-396-1439
Mailing address:
  • Phone: 781-396-1199
  • Fax: 781-396-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number62532
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: