Healthcare Provider Details

I. General information

NPI: 1841720968
Provider Name (Legal Business Name): ANDREA LYNN PICKUP-SIMONIN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-1278
US

IV. Provider business mailing address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-2216
  • Fax:
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN260456
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260456
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: