Provider Demographics
NPI:1497882971
Name:HEGARTY, EILEEN (PNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:HEGARTY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-2947
Mailing Address - Country:US
Mailing Address - Phone:978-452-2200
Mailing Address - Fax:978-441-2550
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-2200
Practice Address - Fax:978-441-2550
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA251543363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA251543OtherSTATE LICENSE
MAMH0655033IOtherMA CONTROL SUBSTANCE
MAMH1514341OtherDEA