Provider Demographics
NPI:1861123788
Name:BUCCELLI, LAUREN NICOLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:NICOLE
Last Name:BUCCELLI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:790 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5938
Mailing Address - Country:US
Mailing Address - Phone:781-505-8700
Mailing Address - Fax:978-670-8548
Practice Address - Street 1:790 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5938
Practice Address - Country:US
Practice Address - Phone:781-505-8700
Practice Address - Fax:978-670-8548
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA8816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant