Basic Information
| Provider Information | |||||||||
| NPI: | 1295202570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLEROSE | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHMIDT | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 147 PELHAM ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018442060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833491 | ||||||||
| FaxNumber: | 9786833058 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 PELHAM ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018442060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786860900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2018 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2328047 | MA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN2328047 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.