Healthcare Provider Details

I. General information

NPI: 1548744576
Provider Name (Legal Business Name): ELLEN S VIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 09/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KOHLRAUSCH AVE
NORTH BILLERICA MA
01862-1451
US

IV. Provider business mailing address

8 KOHLRAUSCH AVE
NORTH BILLERICA MA
01862-1451
US

V. Phone/Fax

Practice location:
  • Phone: 978-944-3519
  • Fax:
Mailing address:
  • Phone: 978-944-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2284655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: