Provider Demographics
NPI:1699890855
Name:MONGIACOTTI, CARLA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LYNN
Last Name:MONGIACOTTI
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:425 OAKHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:857-413-7103
Mailing Address - Fax:508-885-5048
Practice Address - Street 1:77 HASTRUP ROAD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562
Practice Address - Country:US
Practice Address - Phone:774-262-3513
Practice Address - Fax:508-885-5048
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA214054163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0707341OtherMASS HEALTH