Healthcare Provider Details

I. General information

NPI: 1053672667
Provider Name (Legal Business Name): TONI - ANN T REBELO MSN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MAIN ST SUITE 150
STONEHAM MA
02180-3335
US

IV. Provider business mailing address

2 MAIN ST SUITE 150
STONEHAM MA
02180-3335
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-9600
  • Fax: 781-438-9601
Mailing address:
  • Phone: 781-438-9600
  • Fax: 781-438-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License NumberRN264408
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN264408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: