Provider Demographics
NPI:1689031908
Name:PRICOP, PAUL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PRICOP
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:PRICOP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRCATITIONER
Mailing Address - Street 1:819 WORCESTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:819 WORCESTER ST STE 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1056
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:413-543-7962
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner