Healthcare Provider Details

I. General information

NPI: 1215556113
Provider Name (Legal Business Name): ERICA NADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 OLD MILL RD
SHREWSBURY MA
01545-2238
US

IV. Provider business mailing address

271 CAREW ST SURGICAL PA DEPT
SPRINGFIELD MA
01104-2377
US

V. Phone/Fax

Practice location:
  • Phone: 774-437-1713
  • Fax:
Mailing address:
  • Phone: 413-748-7353
  • Fax: 413-748-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA7936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: