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General NPI Number Information
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NPI Number | 1396860235
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Entity Type | Individual
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Provider Name | MARCIA A PANICO NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1230 BRIDGE ST
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City | LOWELL
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State | MA
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Zip | 01850-1261
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Country | US
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Telephone | 978-452-1294
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Fax |
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Provider Business Mailing Address
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Address Line | 168 DAYTON ST
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City | DANVERS
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State | MA
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Zip | 01923-1019
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Country | US
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Telephone | 978-774-7218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 88466
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License Number State | MA
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