Provider Demographics
NPI:1962252775
Name:NVIIRI, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:NVIIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:NVIIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2463
Mailing Address - Country:US
Mailing Address - Phone:508-740-4727
Mailing Address - Fax:
Practice Address - Street 1:131 STATE ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2463
Practice Address - Country:US
Practice Address - Phone:508-740-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2318448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner