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NPI Code Detail

MEDICARE: SHIRLEY KELLY LABRECQUE PMHNP

MEDICARE: SHIRLEY KELLY LABRECQUE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2282556MA

General Provider Information

NPI Number : 1629123526
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY KELLY LABRECQUE PMHNP
Provider Business Mailing Address
First Line : 1794 BRIDGE ST STE 18B
Second Line :
City : DRACUT
State : MA
Zip : 01826-2664
Country : US
Telephone Number : 978-219-6710
Fax Number :
Provider Business Practice Location Address
First Line : 295 VARNUM AVE
Second Line :
City : LOWELL
State : MA
Zip : 01854-2193
Country : US
Telephone Number : 978-788-7418
Fax Number : 978-937-6853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 10/29/2020

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Directions to “ SHIRLEY KELLY LABRECQUE PMHNP” Practice Location

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