Healthcare Provider Details

I. General information

NPI: 1730203993
Provider Name (Legal Business Name): VIRGINIA DUTRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ARROWHEAD PATH
NORTH TRURO MA
02652-0000
US

IV. Provider business mailing address

PO BOX 2033
TRURO MA
02666-2033
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-2325
  • Fax:
Mailing address:
  • Phone: 508-487-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number107010
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: