Individual
MYRNA MENEZES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3 BAYBERRY LN, RANDOLPH, MA 02368-5101
(339) 788-1049
Mailing address
3 BAYBERRY LN, RANDOLPH, MA 02368-5101
(133) 978-8104
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN88760
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S98090805
DRIVER'S LICENSE
MA
Enumeration date
03/21/2022
Last updated
04/05/2022
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