1164778890 NPI number — KARYN LYNN ROSSACCI NP

Table of content: KARYN LYNN ROSSACCI NP (NPI 1164778890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164778890 NPI number — KARYN LYNN ROSSACCI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSACCI
Provider First Name:
KARYN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1164778890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 HOSPITAL RD
Provider Second Line Business Mailing Address:
WING EMERGENCY SERVICES
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-466-2994
Provider Business Mailing Address Fax Number:
978-466-2993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WRIGHT ST
Provider Second Line Business Practice Location Address:
WING MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01069-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-294-5308
Provider Business Practice Location Address Fax Number:
413-284-5704
Provider Enumeration Date:
07/31/2012

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: 363L00000X , with the licence number:  RN256683 , 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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