Individual
EILEEN FRANCES MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1400 VFW PKWY, WEST ROXBURY, MA 02132-4927
(857) 203-6151
Mailing address
41 MOON COMPASS LN, SANDWICH, MA 02563-2766
(617) 462-6011
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
198380
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005008271-21
ADULT NURSE PRACTITIONER
MA
Enumeration date
04/10/2009
Last updated
04/10/2009
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