Healthcare Provider Details

I. General information

NPI: 1770084782
Provider Name (Legal Business Name): TINA VIRGINIA XENAKIS-VETH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 02/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TURNPIKE ST STE 41
NORTH ANDOVER MA
01845-5935
US

IV. Provider business mailing address

48 HIGHLAND AVE
HAVERHILL MA
01830-4156
US

V. Phone/Fax

Practice location:
  • Phone: 978-681-4700
  • Fax:
Mailing address:
  • Phone: 978-376-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN235215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: