Provider Demographics
NPI:1437202686
Name:MALATESTA, ANNMARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:
Last Name:MALATESTA
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 1:100 MERRIMACK AVE
Mailing Address - Street 2:UNIT #B6
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826
Mailing Address - Country:US
Mailing Address - Phone:978-458-6518
Mailing Address - Fax:
Practice Address - Street 1:148 WARREN ST
Practice Address - Street 2:SOUTH BAY EARLY INTERVENTION
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-452-1736
Practice Address - Fax:978-452-6625
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse