Provider Demographics
NPI:1063534998
Name:RODMAN, ANNE (APRN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:RODMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2060
Mailing Address - Country:US
Mailing Address - Phone:978-683-3491
Mailing Address - Fax:978-683-3058
Practice Address - Street 1:70 EAST ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4597
Practice Address - Country:US
Practice Address - Phone:978-683-3491
Practice Address - Fax:978-683-3058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2007OtherBCBS MA
MAUX8684Medicare PIN
MAS89828Medicare UPIN