Provider Demographics
NPI:1194892828
Name:DATILLIO, RN, DESNEIGE M (LIC AC)
Entity type:Individual
Prefix:
First Name:DESNEIGE
Middle Name:M
Last Name:DATILLIO, RN
Suffix:
Gender:F
Credentials:LIC AC
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Mailing Address - Street 1:41 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-3201
Mailing Address - Country:US
Mailing Address - Phone:781-246-8588
Mailing Address - Fax:
Practice Address - Street 1:591 NORTH AVE
Practice Address - Street 2:#2
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1647
Practice Address - Country:US
Practice Address - Phone:781-246-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist