Healthcare Provider Details

I. General information

NPI: 1134206105
Provider Name (Legal Business Name): ROSEMARY CIAVOLA CICCARELLI ANP, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 WESTERN AVE
WESTFIELD MA
01086-1630
US

IV. Provider business mailing address

P.O. BOX 1630 WESTFIELD STATE COLLEGE
WESTFIELD MA
01086-1630
US

V. Phone/Fax

Practice location:
  • Phone: 413-572-5415
  • Fax: 413-572-5545
Mailing address:
  • Phone: 413-572-5415
  • Fax: 413-572-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number92766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: