Individual
WIBIE S ALTIDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
165 QUINCY ST, BROCKTON, MA 02302-2988
(508) 897-2092
Mailing address
165 QUINCY ST, BROCKTON, MA 02302-2988
(508) 897-2092
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN9400
MA
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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