Provider Demographics
NPI:1013925817
Name:RENAGHAN, DARCY P (NP)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:P
Last Name:RENAGHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1735
Mailing Address - Country:US
Mailing Address - Phone:508-543-8595
Mailing Address - Fax:508-698-5373
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-543-8595
Practice Address - Fax:508-698-5373
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196079363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9886OtherMABC
MANP3445Medicare ID - Type Unspecified
MANP9886OtherMABC