1710211446 NPI number — MRS. KELLY ANN NOSKA ANP-BC

Table of content: MRS. KELLY ANN NOSKA ANP-BC (NPI 1710211446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710211446 NPI number — MRS. KELLY ANN NOSKA ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOSKA
Provider First Name:
KELLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710211446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 MAIN ST
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-849-7507
Provider Business Mailing Address Fax Number:
978-371-0522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 ERDMAN WAY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-371-7010
Provider Business Practice Location Address Fax Number:
978-371-0522
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  265158 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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