Healthcare Provider Details

I. General information

NPI: 1801082433
Provider Name (Legal Business Name): TERESA REARDON-POLLINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 LOW ST
NEWBURYPORT MA
01950-3556
US

IV. Provider business mailing address

257 LOW ST
NEWBURYPORT MA
01950-3556
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-9311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number150835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: