Individual
MARY R INNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN PC
Contact information
Practice address
100 CENTURY DR, WORCESTER, MA 01606
(508) 762-5400
(508) 762-5410
Mailing address
PO BOX 415348 PROVIDER ENROLLMENT, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
167110
MA
Other
Enumeration date
05/23/2006
Last updated
11/24/2020
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