Healthcare Provider Details

I. General information

NPI: 1225762115
Provider Name (Legal Business Name): LORIMAR CRUZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MAIN ST STE 101
SPRINGFIELD MA
01107-1078
US

IV. Provider business mailing address

3550 MAIN ST STE 101
SPRINGFIELD MA
01107-1078
US

V. Phone/Fax

Practice location:
  • Phone: 413-858-7400
  • Fax: 413-746-0380
Mailing address:
  • Phone: 413-858-7400
  • Fax: 413-746-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2279922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: