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General NPI Number Information
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NPI Number | 1013798826
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Entity Type | Organization
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Legal Business Name | SPROUTS HEALTH CLINIC INC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 300 BAKER AVE # 300A
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City | CONCORD
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State | MA
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Zip | 01742-2131
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Country | US
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Telephone | 857-417-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 24 WARREN AVE # AVA
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City | CHELMSFORD
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State | MA
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Zip | 01824-3043
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Country | US
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Telephone | 857-417-5688
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MARIAM KALUBA SSOZI
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Credential | NP
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Telephone | 857-417-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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