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General NPI Number Information
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NPI Number | 1487026399
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Entity Type | Individual
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Provider Name | PAULINE ETENG
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Gender | Female
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 16 SWEET GRASS LN
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City | HOLLISTON
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State | MA
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Zip | 01746-2532
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Country | US
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Telephone | 774-217-0608
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Fax |
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Provider Business Mailing Address
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Address Line | 309 BELMONT STREET WORCESTER RECOVERY CENTER AND HOSPITAL
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City | WORCESTER
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State | MA
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Zip | 01604
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Country | US
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Telephone | 508-368-4000
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | RN281216
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License Number State | MA
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