Provider Demographics
NPI:1689173866
Name:VIVOAMORE, MICHELLE (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VIVOAMORE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5517
Mailing Address - Country:US
Mailing Address - Phone:978-233-1594
Mailing Address - Fax:877-247-8587
Practice Address - Street 1:142 LOWELL RD UNIT 17-151
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4938
Practice Address - Country:US
Practice Address - Phone:978-233-1594
Practice Address - Fax:877-247-8587
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH083943-23363LP0808X, 363LP0808X
MARN2313491363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHCP12151114807OtherCLOZAPINE REMS PROGRAM
NH3127474Medicaid
MA110153729AMedicaid