Healthcare Provider Details

I. General information

NPI: 1295063626
Provider Name (Legal Business Name): PLYMOUTH CARVER PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONG POND RD SUITE 212
PLYMOUTH MA
02360-2642
US

IV. Provider business mailing address

110 LONG POND RD SUITE 212
PLYMOUTH MA
02360-2642
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-7272
  • Fax: 508-746-0104
Mailing address:
  • Phone: 508-746-7272
  • Fax: 508-746-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER JANE CONWAY
Title or Position: NURSE PRACTITIONER
Credential: ANP- BC
Phone: 508-746-7272