Theresa Lydia Deroy
Individual provider Active NPI Registered Nurse · Douglas, MA
NPI 1972636736 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1972636736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 175554 (MA)
- Practice address
- 753 NW Main St
Douglas, MA 01516-2802 - Phone
- (508) 476-1112
- Fax
- (508) 476-2444
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 175554 | MA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 175554 | MA | Yes |
Addresses
Primary practice location
753 NW Main St
Douglas, MA 01516-2802
Mailing address
753 NW Main St
Douglas, MA 01516-2802
Phone (508) 476-1112
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0708119 | Medicaid | MA |
Other providers in Douglas, MA
- Bfox Counseling LLC
- Blackstone Valley Natural Health Center, P.C.
- Danya Lee Butterfield
- Kimberly Charbonneau
- CLP Enterprises Inc.
- Douglas Public Schools
- Joseph Dumont
- Foundational Pathways Learning Center, LLC
- Mike Elliot Govoni
- Joann Griffin
All providers in Douglas, MA · Registered Nurse in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.