Provider Demographics
NPI:1861776064
Name:PANNESI, RO ANDERSEN (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:RO
Middle Name:ANDERSEN
Last Name:PANNESI
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MRS
Other - First Name:RO
Other - Middle Name:KILLORY
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:126 PHOENIX AVE.
Mailing Address - Street 2:ANNE SULLIVAN CTR. EARLY INTERVENTION
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-453-8331
Mailing Address - Fax:978-453-9254
Practice Address - Street 1:126 PHOENIX AVE. 3RD FLOOR
Practice Address - Street 2:ANNE SULLIVAN EARLY INTERVENTION CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:978-453-9254
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243125163W00000X
MA19411646163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant