Provider Demographics
NPI:1821240516
Name:DENIS, IMMACULA (RN)
Entity Type:Individual
Prefix:MS
First Name:IMMACULA
Middle Name:
Last Name:DENIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AVON CT
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2202
Mailing Address - Country:US
Mailing Address - Phone:781-245-2913
Mailing Address - Fax:781-245-8982
Practice Address - Street 1:2 AVON CT
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2202
Practice Address - Country:US
Practice Address - Phone:781-245-2913
Practice Address - Fax:781-245-8982
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse