Individual
MS. SHANNON MARIE DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(617) 665-1000
Mailing address
147 OAKLAND ST, MALDEN, MA 02148-6524
(781) 333-1716
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN90257
MA
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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