Provider Demographics
NPI:1881653905
Name:PUGLIELLI, ERICA D (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:D
Last Name:PUGLIELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:DEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:79 ERDMAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-4805
Mailing Address - Fax:978-537-2185
Practice Address - Street 1:79 ERDMAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-537-4805
Practice Address - Fax:978-537-2185
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233869363LF0000X
MARN233869363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
93059OtherFALLON HP
NP3941OtherBCBS MA
P70092Medicare UPIN
MANP394101Medicare PIN
93059OtherFALLON HP