Provider Demographics
NPI:1932362613
Name:NORTH SHORE NURSE PRACTITIONER ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTH SHORE NURSE PRACTITIONER ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RAUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:978-750-0755
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-750-0755
Mailing Address - Fax:978-750-0766
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 300A
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-750-0755
Practice Address - Fax:978-750-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2017572084P0800X
MA1250492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1893327Medicaid
MA1893327Medicaid