Provider Demographics
NPI:1497740666
Name:SWEETALL, JOY (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:SWEETALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORPORATION WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7932
Mailing Address - Country:US
Mailing Address - Phone:978-977-2688
Mailing Address - Fax:978-573-4395
Practice Address - Street 1:2 CORPORATION WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7932
Practice Address - Country:US
Practice Address - Phone:978-977-2688
Practice Address - Fax:978-573-4395
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA162638363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0702954Medicaid
MANP4963Medicare ID - Type Unspecified
MA0702954Medicaid