Individual
CASSANDRA THEODORIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
Mailing address
1440 EASTERN AVE, MALDEN, MA 02148-6112
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN2312573
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN2312573
MA
Other
Enumeration date
01/11/2019
Last updated
06/02/2022
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