Healthcare Provider Details

I. General information

NPI: 1528089554
Provider Name (Legal Business Name): PATRICIA M. SENIOR RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LAKE AVE N STE 101
WORCESTER MA
01605-2073
US

IV. Provider business mailing address

425 LAKE AVE N STE 101
WORCESTER MA
01605-2073
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3220
  • Fax: 508-753-3224
Mailing address:
  • Phone: 508-753-3220
  • Fax: 508-753-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number129145
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number129145
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: