Healthcare Provider Details

I. General information

NPI: 1952394009
Provider Name (Legal Business Name): PATRICIA E CORCORAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 MAIN ST
WALPOLE MA
02081-2954
US

IV. Provider business mailing address

844 MAIN ST
WALPOLE MA
02081-2954
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-4555
  • Fax: 508-668-9062
Mailing address:
  • Phone: 508-668-4555
  • Fax: 508-668-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number160779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: