Individual
HEIDI COLLINS FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
19 BROADWAY, BEVERLY, MA 01915-4417
(978) 927-9824
Mailing address
139 CLIFF AVE, WINTHROP, MA 02152-1007
(617) 539-1857
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
194537
MA
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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