Individual
MRS. ANN OSAMUDIAIMEN IRORERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
155 SOUTH LEYDEN ST, BROCKTON, MA 02302
(508) 345-6313
Mailing address
155 SOUTH LEYDEN ST, BROCKTON, MA 02302
(508) 345-6313
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2257719
MA
363LA2200X
Adult Health Nurse Practitioner
N2257719
MA
363LA2200X
Adult Health Nurse Practitioner
RN2257719
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2257719
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163W00000X
—
MA
Enumeration date
10/27/2011
Last updated
01/02/2024
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