=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215556113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA NADER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2020
-----------------------------------------------------
Last Update Date | 06/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 158 OLD MILL RD
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01545-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-437-1713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 271 CAREW ST SURGICAL PA DEPT
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01104-2377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-748-7353
-----------------------------------------------------
Fax | 413-748-7357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA7936
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------