Individual
MESA OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(781) 338-0500
Mailing address
3844 GLOUCESTER RD, ROCKY MOUNT, NC 27803-1109
(252) 567-7056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
234343
NC
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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