Healthcare Provider Details

I. General information

NPI: 1609127422
Provider Name (Legal Business Name): RCNA1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 TURNPIKE ST
NORTH ANDOVER MA
01845-5032
US

IV. Provider business mailing address

129 TURNPIKE ST
NORTH ANDOVER MA
01845-5032
US

V. Phone/Fax

Practice location:
  • Phone: 978-470-0800
  • Fax:
Mailing address:
  • Phone: 978-470-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NELSON
Title or Position: PROJECT MANAGER
Credential:
Phone: 413-754-3305