Individual
JULIE GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
300 BROADWAY, SOMERVILLE, MA 02145-2935
(617) 284-7000
Mailing address
31 JULIA ST, MALDEN, MA 02148-6503
(617) 763-9107
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN53023
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LN53023
NURSING LICENSE, LPN
MA
Enumeration date
03/01/2018
Last updated
03/01/2018
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