Individual
COURTNEY AVIS HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
984 SHARON ST APT L, NEW BEDFORD, MA 02745-4745
(508) 317-7557
Mailing address
984 SHARON ST APT L, NEW BEDFORD, MA 02745-4745
(508) 317-7557
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN 93008
MA
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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