Provider Demographics
NPI:1790332435
Name:WEBSTER, THERESA (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1782
Mailing Address - Country:US
Mailing Address - Phone:978-685-8800
Mailing Address - Fax:
Practice Address - Street 1:290 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1782
Practice Address - Country:US
Practice Address - Phone:978-685-8800
Practice Address - Fax:978-685-8808
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAPRN2269826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health