Individual
PANIDA PHEANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
200 GROTON RD, AYER, MA 01432-1168
(978) 784-9328
(978) 784-9666
Mailing address
200 GROTON RD, AYER, MA 01432-1168
(978) 784-9328
(978) 784-9666
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN2296859
MA
363LG0600X
Gerontology Nurse Practitioner
RN2296859
MA
363LX0106X
Occupational Health Nurse Practitioner
RN2296859
MA
Other
Enumeration date
12/19/2022
Last updated
08/30/2024
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