Healthcare Provider Details

I. General information

NPI: 1497783799
Provider Name (Legal Business Name): CLAUDIA PHILLIPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY MEDICAL CENTER 271 CAREW ST
SPRINGFIELD MA
01102
US

IV. Provider business mailing address

81 LONG PLAIN RD
LEVERETT MA
01054-9523
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-9064
  • Fax: 413-748-9049
Mailing address:
  • Phone: 413-548-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number169506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: