Individual
LORAE D. PHELAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MS,CS
Contact information
Practice address
110 GREAT RD, SUITE 205, BEDFORD, MA 01730-2729
(617) 529-7772
(781) 687-2018
Mailing address
100 WOODLAND RD, MALDEN, MA 02148-1135
(781) 388-2394
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
163625
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013504
PACIFICARE INSUR
MA
01
—
113345
INSURANCE
MA
01
—
163625
TUFTS INSURANCE
MA
01
—
PN0762
BLUE CROSS/BLUE SHIELD IN
MA
Enumeration date
08/01/2006
Last updated
07/08/2007
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