Provider Demographics
NPI:1912926288
Name:DELOUCHRY, TINA M (NP)
Entity Type:Individual
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First Name:TINA
Middle Name:M
Last Name:DELOUCHRY
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Gender:F
Credentials:NP
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Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:29 HUDSON RD STE 3310
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1753
Practice Address - Country:US
Practice Address - Phone:978-443-8810
Practice Address - Fax:978-443-8839
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-04
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Provider Licenses
StateLicense IDTaxonomies
MA250697363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP5322OtherBC-BS OF MASS
MAQ67986Medicare UPIN
MANP5322OtherBC-BS OF MASS