Provider Demographics
NPI:1437283736
Name:AGGANIS, GEORGIA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:
Last Name:AGGANIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LITTLETON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3198
Mailing Address - Country:US
Mailing Address - Phone:978-577-0437
Mailing Address - Fax:
Practice Address - Street 1:133 LITTLETON RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3198
Practice Address - Country:US
Practice Address - Phone:978-577-0437
Practice Address - Fax:978-692-9904
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251067363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA06246721OtherCONTROLLED SUBSTANCE LICE
MA251067OtherSTATE NP LICENSE