Individual
MARY S BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
671 MAIN ST, WALTHAM, MA 02451-0602
(781) 647-3040
(781) 647-3044
Mailing address
47 HIGH STREET SUITE 101, NORTH ANDOVER, MA 01845
(978) 685-2460
(978) 685-2572
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
158347
MA
Other
Enumeration date
10/20/2006
Last updated
07/28/2017
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