Provider Demographics
NPI:1194868687
Name:SEARS, VIVIAN (APN)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BURLEY ST
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1904
Mailing Address - Country:US
Mailing Address - Phone:978-774-5943
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE 301A
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:617-605-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANP82520363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1641Medicare ID - Type UnspecifiedGNP
MAS73927Medicare UPIN