Provider Demographics
NPI:1770084782
Name:XENAKIS-VETH, TINA VIRGINIA (CNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:VIRGINIA
Last Name:XENAKIS-VETH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4156
Mailing Address - Country:US
Mailing Address - Phone:978-376-9863
Mailing Address - Fax:
Practice Address - Street 1:555 TURNPIKE ST STE 41
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5935
Practice Address - Country:US
Practice Address - Phone:978-681-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN235215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily