Provider Demographics
NPI:1902411341
Name:DICREDICO, ANNE MARIE MARIE
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:MARIE
Last Name:DICREDICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 SHERWOOD FOREST LN UNIT 916
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1973
Mailing Address - Country:US
Mailing Address - Phone:781-258-4561
Mailing Address - Fax:
Practice Address - Street 1:916 SHERWOOD FOREST LN UNIT 916
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1973
Practice Address - Country:US
Practice Address - Phone:781-258-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN173023363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health