Provider Demographics
NPI:1346257474
Name:NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC
Entity type:Organization
Organization Name:NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-712-1233
Mailing Address - Street 1:800 W CUMMINGS PARK STE 5000
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6356
Mailing Address - Country:US
Mailing Address - Phone:781-756-2488
Mailing Address - Fax:781-756-2654
Practice Address - Street 1:800 W CUMMINGS PARK STE 5000
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6356
Practice Address - Country:US
Practice Address - Phone:781-756-2488
Practice Address - Fax:781-756-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAT6IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0608513Medicaid
MA227495Medicare Oscar/Certification
MA0608513Medicaid