Provider Demographics
NPI:1124422944
Name:GREATER LOWELL PRIVATE NURSING SERVICES AND EDUCATION
Entity type:Organization
Organization Name:GREATER LOWELL PRIVATE NURSING SERVICES AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-804-5379
Mailing Address - Street 1:963 CHELMSFORD STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851
Mailing Address - Country:US
Mailing Address - Phone:978-455-5340
Mailing Address - Fax:978-677-6711
Practice Address - Street 1:963 CHELMSFORD STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851
Practice Address - Country:US
Practice Address - Phone:978-455-5340
Practice Address - Fax:978-677-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN 272019251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health