Provider Demographics
NPI:1871884759
Name:RWENZO, DOREEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:RWENZO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CORTLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-2014
Mailing Address - Country:US
Mailing Address - Phone:781-513-2231
Mailing Address - Fax:
Practice Address - Street 1:10 ESKIMO WAY
Practice Address - Street 2:
Practice Address - City:N BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2900
Practice Address - Country:US
Practice Address - Phone:781-350-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health