1578227492 NPI number — MARY BULL SETERDAHL FNP

Table of content: MARY BULL SETERDAHL FNP (NPI 1578227492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578227492 NPI number — MARY BULL SETERDAHL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SETERDAHL
Provider First Name:
MARY
Provider Middle Name:
BULL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1578227492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 CONWAY ST
Provider Second Line Business Mailing Address:
GREENFIELD HEALTH CENTER
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01301-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-774-6301
Provider Business Mailing Address Fax Number:
866-644-0871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 CONWAY ST
Provider Second Line Business Practice Location Address:
GREENFIELD HEALTH CENTER
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-774-6301
Provider Business Practice Location Address Fax Number:
866-644-0871
Provider Enumeration Date:
10/27/2021

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: 163W00000X , with the licence number:  RN2291170 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN2291170 , 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)