Provider Demographics
NPI:1710563457
Name:ANDERSON, DARLENE RITA (LPN)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:RITA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2405
Mailing Address - Country:US
Mailing Address - Phone:978-535-9190
Mailing Address - Fax:978-535-9093
Practice Address - Street 1:172 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2405
Practice Address - Country:US
Practice Address - Phone:978-535-9190
Practice Address - Fax:978-535-9093
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN32567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse