Basic Information
| Provider Information | |||||||||
| NPI: | 1245887801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDRY | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | RN BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785370956 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785370956 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN2317473 | MA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.