Healthcare Provider Details

I. General information

NPI: 1326351453
Provider Name (Legal Business Name): IZABELA MALGORZATA OMONDI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IZABEAL MALGORZATA FANUEF RN

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN STREET
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

26 QUEEN STREET
WORCESTER MA
01610-2473
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7800
  • Fax: 508-860-7925
Mailing address:
  • Phone: 508-860-7800
  • Fax: 508-860-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2266427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: