Healthcare Provider Details

I. General information

NPI: 1174954754
Provider Name (Legal Business Name): NANCY BIRRER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

IV. Provider business mailing address

46 SERVICE RD
EAST SANDWICH MA
02537-1577
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-3514
  • Fax:
Mailing address:
  • Phone: 508-332-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number8508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: