Healthcare Provider Details

I. General information

NPI: 1093214710
Provider Name (Legal Business Name): BERENICE TCHANDJIB KOBU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 TREBLE COVE RD
NORTH BILLERICA MA
01862
US

IV. Provider business mailing address

382 TREBLE COVE RD
NORTH BILLERICA MA
01862-2823
US

V. Phone/Fax

Practice location:
  • Phone: 781-267-2131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2283463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: