Provider Demographics
NPI:1164543690
Name:DEMYT, DENISE (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DEMYT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4576
Mailing Address - Country:US
Mailing Address - Phone:781-235-0387
Mailing Address - Fax:
Practice Address - Street 1:859 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-4576
Practice Address - Country:US
Practice Address - Phone:781-235-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0328120Medicare ID - Type UnspecifiedNURSE