Healthcare Provider Details

I. General information

NPI: 1144705443
Provider Name (Legal Business Name): NVP PODIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 LOWELL ST STE 102
WAKEFIELD MA
01880-1984
US

IV. Provider business mailing address

380 LOWELL ST STE 102
WAKEFIELD MA
01880-1984
US

V. Phone/Fax

Practice location:
  • Phone: 781-224-3669
  • Fax:
Mailing address:
  • Phone: 781-224-3668
  • Fax: 781-224-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: NANCY V. PRECHTL
Title or Position: OWNER
Credential: DPM
Phone: 781-224-3668