Provider Demographics
NPI:1144317710
Name:TEMPESTA, LAUREN A (PCNS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:TEMPESTA
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WESTVALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-387-2220
Mailing Address - Fax:617-394-0538
Practice Address - Street 1:617 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETTE
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:617-387-2220
Practice Address - Fax:617-394-0538
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN142157364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult