MEDICARE: TINA VIRGINIA XENAKIS-VETH CNP

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
1	363LF0000X	Family Nurse Practitioner	RN235215	MA

General Provider Information

NPI Number	:	1770084782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA VIRGINIA XENAKIS-VETH CNP

Provider Business Mailing Address
First Line	:	48 HIGHLAND AVE
Second Line	:
City	:	HAVERHILL
State	:	MA
Zip	:	01830-4156
Country	:	US
Telephone Number	:	978-376-9863
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 TURNPIKE ST STE 41
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5935
Country	:	US
Telephone Number	:	978-681-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	02/24/2018

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