Healthcare Provider Details

I. General information

NPI: 1407623747
Provider Name (Legal Business Name): ASHLEY SNOW TETREAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 INGALLS CT
METHUEN MA
01844-3712
US

IV. Provider business mailing address

88 MAIN ST
LOWELL MA
01852-4445
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-2807
  • Fax:
Mailing address:
  • Phone: 978-995-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2390184
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: