Individual
MR. EDWARD LEO REARDON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
17 MCHUGH AVE, BILLERICA, MA 01821-5941
(978) 667-5804
Mailing address
17 MCHUGH AVE, BILLERICA, MA 01821-5941
(978) 667-5804
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
58456
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0711233
INDEPENDENT NURSE
MA
Enumeration date
03/16/2007
Last updated
07/08/2007
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