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General NPI Number Information
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NPI Number | 1326178062
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CLINICAL ALLIANCE
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 380 PLAINFIELD ST
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1524
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Country | US
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Telephone | 888-255-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 380 PLAINFIELD ST
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1524
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Country | US
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Telephone | 888-255-4525
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LYNN ANN MINNICK
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Credential | NP
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Telephone | 18882554525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 252442
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License Number State | MA
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