Provider Demographics
NPI:1568045607
Name:CORMIER, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CORMIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-8142
Mailing Address - Country:US
Mailing Address - Phone:978-343-6300
Mailing Address - Fax:978-343-2803
Practice Address - Street 1:155 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8142
Practice Address - Country:US
Practice Address - Phone:978-343-6300
Practice Address - Fax:978-343-2803
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN46242164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALN46242OtherLICENSED PRACTICAL NURSE