Provider Demographics
NPI:1265276729
Name:FRONGILLO, LORRAINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:FRONGILLO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:SIMONEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 CENTENNIAL DR # 21
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7901
Mailing Address - Country:US
Mailing Address - Phone:978-944-7288
Mailing Address - Fax:
Practice Address - Street 1:19 CENTENNIAL DR # 21
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7901
Practice Address - Country:US
Practice Address - Phone:978-944-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily