Individual
MARY LOU RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNCS
Contact information
Practice address
40 HOLLAND ST, SOMERVILLE, MA 02144-2705
(617) 629-6180
Mailing address
40 HOLLAND ST, HVMA, SOMERVILLE, MA 02144-2705
(617) 629-6180
(617) 629-6041
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
150000
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036952
NEIGHBORHOOD HEALTH PLAN
MA
01
—
669498
TUFTS HEALTH PLAN
MA
01
—
PN0575
BLUE CROSS
MA
Enumeration date
07/22/2006
Last updated
10/07/2010
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