Healthcare Provider Details

I. General information

NPI: 1366854481
Provider Name (Legal Business Name): CAROL REICH FNP-BC, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL WOLCOTT

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOSPITAL DR
WINCHENDON MA
01475-1820
US

IV. Provider business mailing address

55 HOSPITAL DR
WINCHENDON MA
01475-1820
US

V. Phone/Fax

Practice location:
  • Phone: 978-297-2311
  • Fax:
Mailing address:
  • Phone: 978-297-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2271151
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2271151
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: