Individual
MARY LODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1135 MORTON ST, MATTAPAN, MA 02126-2834
(617) 533-2300
(617) 533-2341
Mailing address
1135 MORTON ST, MATTAPAN, MA 02126-2834
(617) 533-2300
(617) 533-2341
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
173354
MA
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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