Provider Demographics
NPI:1598435547
Name:CUMMINGS, DEREK MARTIN (CNP)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:MARTIN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:NORTH PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02358-0038
Mailing Address - Country:US
Mailing Address - Phone:781-727-9558
Mailing Address - Fax:
Practice Address - Street 1:332 KEENE ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3012
Practice Address - Country:US
Practice Address - Phone:781-727-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269674363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care