Judith Louise Formanek, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

186429 Issued in MA

Practice address

101 Amesbury St
Suite 202
Lawrence, MA 01840-1323

Phone

(978) 681-5258

Fax

(978) 681-5387

NPI assigned

Feb 1, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689712911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 PINE RD",
            "city": "WESTFORD",
            "state": "MA",
            "postal_code": "018861421",
            "telephone_number": "978-692-0994",
            "fax_number": "978-681-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 AMESBURY ST",
            "address_2": "SUITE 202",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018401323",
            "telephone_number": "978-681-5258",
            "fax_number": "978-681-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "JUDITH",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MA",
            "license": "186429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NP 3248",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Women's Health Nurse Practitioner in Lawrence, MA
• Providers in Lawrence, MA by specialty
• Women's Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.