Provider Demographics
NPI:1821639725
Name:HUGHES, FANTASIA (LPN)
Entity type:Individual
Prefix:
First Name:FANTASIA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MERRIMACK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1783
Mailing Address - Country:US
Mailing Address - Phone:978-655-5349
Mailing Address - Fax:978-655-6028
Practice Address - Street 1:290 MERRIMACK ST STE 205
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1783
Practice Address - Country:US
Practice Address - Phone:978-655-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2356350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily