Healthcare Provider Details

I. General information

NPI: 1689031908
Provider Name (Legal Business Name): PAUL PRICOP NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL PRICOP NURSE PRCATITIONER

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WORCESTER ST STE 3
SPRINGFIELD MA
01151-1056
US

IV. Provider business mailing address

819 WORCESTER ST STE 3
SPRINGFIELD MA
01151-1056
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-6820
  • Fax: 413-543-7962
Mailing address:
  • Phone: 413-543-6820
  • Fax: 413-543-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2272015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: