Individual
MARY LOU ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCNS-BC
Contact information
Practice address
5 OAK HILL RD, NATICK, MA 01760-1009
(617) 877-0371
Mailing address
5 OAK HILL RD, NATICK, MA 01760-1009
(617) 877-0371
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN111702
MA
Other
Enumeration date
12/29/2019
Last updated
12/29/2019
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