Basic Information
Provider Information
NPI: 1568706612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WORMANN
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5 MULBERRY LN
Address2:  
City: NORTHBOROUGH
State: MA
PostalCode: 015321835
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 354 WAVERLY ST
Address2:  
City: FRAMINGHAM
State: MA
PostalCode: 017027079
CountryCode: US
TelephoneNumber: 5082705700
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/15/2012
LastUpdateDate: 11/15/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN2280311MAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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