Healthcare Provider Details

I. General information

NPI: 1780955500
Provider Name (Legal Business Name): JENNY MARIA VIEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY MARIA VIEIRA FNP

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 MAIN STREET
SOUTH WALPOLE MA
02071
US

IV. Provider business mailing address

2405 SOUTH MAIN STREET
SOUTH WALPOLE MA
02071
US

V. Phone/Fax

Practice location:
  • Phone: 508-660-8000
  • Fax: 617-727-4450
Mailing address:
  • Phone: 508-660-8000
  • Fax: 617-727-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number272660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: