Provider Demographics
NPI:1063024693
Name:ERRATH, NAOMI KIMBALL (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:KIMBALL
Last Name:ERRATH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:KIMBALL
Other - Last Name:WEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:200 BAKER AVENUE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-7495
Mailing Address - Fax:978-287-7494
Practice Address - Street 1:200 BAKER AVENUE
Practice Address - Street 2:SUITE 217
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-7495
Practice Address - Fax:978-287-7494
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328912163W00000X
MA2020014295363LF0000X
MAAPRN2328912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110165503AMedicaid