Provider Demographics
NPI:1104033919
Name:RIZZO, LORRAINE CAROL (APRNBC)
Entity Type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:CAROL
Last Name:RIZZO
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2714
Mailing Address - Country:US
Mailing Address - Phone:617-327-8239
Mailing Address - Fax:
Practice Address - Street 1:750 WASHINGTON ST # 235
Practice Address - Street 2:NEW ENGLAND MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-1625
Practice Address - Fax:617-636-9712
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN86395-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP 1710Medicare ID - Type Unspecified