Individual
MS. JUDITH LOUISE FORMANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 AMESBURY ST, SUITE 202, LAWRENCE, MA 01840-1323
(978) 681-5258
(978) 681-5387
Mailing address
33 PINE RD, WESTFORD, MA 01886-1421
(978) 692-0994
(978) 681-5387
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
186429
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP 3248
BCBS
MA
Enumeration date
02/01/2007
Last updated
07/08/2007
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