Basic Information
| Provider Information | |||||||||
| NPI: | 1568457083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADUA | ||||||||
| FirstName: | NELLY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ESSEX ST | ||||||||
| Address2: | 700 ESSEX STREET | ||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018414396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786892400 | ||||||||
| FaxNumber: | 9786830663 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 ESSEX ST | ||||||||
| Address2: | 700 ESSEX STREET | ||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786892400 | ||||||||
| FaxNumber: | 9786830663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 207263 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1303775 | 05 | MA | MEDICAID |