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General NPI Number Information
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NPI Number | 1700537123
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Entity Type | Individual
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Provider Name | ALEXIS PENA NP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 100 GROVE ST
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City | SHREWSBURY
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State | MA
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Zip | 01545-4695
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Country | US
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Telephone | 508-868-8997
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Fax |
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Provider Business Mailing Address
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Address Line | 28 LAKE AVE
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City | WORCESTER
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State | MA
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Zip | 01604-5823
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2273892
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License Number State | MA
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