Provider Demographics
NPI:1295871218
Name:PEARSON, NANCY (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:200 E MAIN ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2638
Mailing Address - Country:US
Mailing Address - Phone:508-478-4982
Mailing Address - Fax:508-478-6791
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2525
Practice Address - Country:US
Practice Address - Phone:508-478-4982
Practice Address - Fax:508-478-6791
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA110521363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP65308Medicare UPIN