1689173866 NPI number — MICHELLE VIVOAMORE CNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689173866 NPI number — MICHELLE VIVOAMORE CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIVOAMORE
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1689173866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 MAIN ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-233-1594
Provider Business Mailing Address Fax Number:
877-247-8587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 LOWELL RD UNIT 17-151
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03051-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-233-1594
Provider Business Practice Location Address Fax Number:
877-247-8587
Provider Enumeration Date:
02/02/2018

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: 363LP0808X , with the licence number:  083943-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: RN2313491 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HCP12151114807 . This is a "CLOZAPINE REMS PROGRAM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3127474 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110153729A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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