Provider Demographics
NPI:1770626103
Name:LEDERMAN, JOAN ELLEN (NP)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELLEN
Last Name:LEDERMAN
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 1:11 ELSEMILLER TER
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-2815
Mailing Address - Country:US
Mailing Address - Phone:508-877-0447
Mailing Address - Fax:
Practice Address - Street 1:11 ELSEMILLER TER
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-2815
Practice Address - Country:US
Practice Address - Phone:508-877-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129899363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0363481Medicaid
MANP3438Medicare ID - Type UnspecifiedNURSE PRACTITIONER
MA0363481Medicaid