1538550876 NPI number — ROCHELLE BELL ETTLINGER NURSE PRACTITIONER

Table of content: ROCHELLE BELL ETTLINGER NURSE PRACTITIONER (NPI 1538550876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538550876 NPI number — ROCHELLE BELL ETTLINGER NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETTLINGER
Provider First Name:
ROCHELLE
Provider Middle Name:
BELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1538550876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 HIGHLAND AVENUE
Provider Second Line Business Mailing Address:
WINCHESTER HOSPITAL-DEPARTMENT OF PSYCHIATRY
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01890-1496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-756-2734
Provider Business Mailing Address Fax Number:
781-756-7283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 HIGHLAND AVENUE
Provider Second Line Business Practice Location Address:
WINCHESTER HOSPITAL-DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01890-1496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-756-2734
Provider Business Practice Location Address Fax Number:
781-756-7283
Provider Enumeration Date:
02/09/2015

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: 364SP0808X , with the licence number:  RN2278013 , 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)