=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659108074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 ALUMNI DR
-----------------------------------------------------
City | EXETER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03833-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-772-2981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 W CUMMINGS PARK STE 5000
-----------------------------------------------------
City | WOBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01801-6356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-712-1309
-----------------------------------------------------
Fax | 781-756-2654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | DEBORAH COSTELLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-712-1233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------