Healthcare Provider Details

I. General information

NPI: 1831852516
Provider Name (Legal Business Name): DIONNE BOTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673B WHITE ST
SPRINGFIELD MA
01108-3239
US

IV. Provider business mailing address

230 MAPLE ST
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 413-675-5333
  • Fax:
Mailing address:
  • Phone: 413-420-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10137
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: