Provider Demographics
NPI:1649532391
Name:MAFFEI, CIERA JOYCE (CPNP)
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:JOYCE
Last Name:MAFFEI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 549
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0549
Mailing Address - Country:US
Mailing Address - Phone:508-477-5306
Mailing Address - Fax:508-477-0297
Practice Address - Street 1:55 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-0549
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:508-477-0297
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241970208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1174794523Medicaid