Healthcare Provider Details

I. General information

NPI: 1861690810
Provider Name (Legal Business Name): NANCY VIRGINIA PRECHTL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
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: 781-224-3668
  • Fax: 812-243-6677
Mailing address:
  • Phone: 781-224-3668
  • Fax: 817-224-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2306
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2306
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: