Individual
MRS. MALISSA SUSANNE CHRISTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1127 BRIDGE ST, LOWELL, MA 01850-1206
(978) 459-7034
Mailing address
1127 BRIDGE ST, LOWELL, MA 01850-1206
(978) 459-7034
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
66265
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0710873
MASS HEALTH PROVIDER
MA
Enumeration date
05/21/2007
Last updated
07/08/2007
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