Provider Demographics
NPI:1780251793
Name:TEIXEIRA, LUCETTE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:LUCETTE
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4098
Mailing Address - Country:US
Mailing Address - Phone:617-445-6538
Mailing Address - Fax:
Practice Address - Street 1:30 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4098
Practice Address - Country:US
Practice Address - Phone:617-445-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270169363L00000X, 363LP2300X, 163WH0200X, 363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health