=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114114758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELROSE MAE LAHOOD NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2007
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 WORCESTER ST SUITE 3
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01151-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-543-6820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 391 PLEASANT ST
-----------------------------------------------------
City | LEICESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01524-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-892-1969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 184642
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 184642
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------