Basic Information
| Provider Information | |||||||||
| NPI: | 1215570676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RICOT | ||||||||
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| Credential: | DNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 479 WASHINGTON ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8575295220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 479 WASHINGTON ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8575295220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2019 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2319463 | MA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN2319463 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.