Healthcare Provider Details

I. General information

NPI: 1215997903
Provider Name (Legal Business Name): DONNA A CIACCIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CENTRE STREET
WEST ROXBURY MA
02132
US

IV. Provider business mailing address

192 SYCAMORE STREET
ROSLINDALE MA
02131
US

V. Phone/Fax

Practice location:
  • Phone: 617-325-6700
  • Fax: 617-325-6581
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234774
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: