Individual
MS. MARY-ELLIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
83 LITTLEFIELD RD, NEWTON, MA 02459-3010
(617) 928-1530
(617) 928-1531
Mailing address
48 MAVERICK ST, DEDHAM, MA 02026-2436
(781) 326-8193
(781) 326-8193
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
160595
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0327484
—
MA
01
—
NP4210
BC/BS PROVIDER NUMBER
MA
01
—
P00043183
RR-FEDERAL BLUE CROSS
MA
Enumeration date
06/16/2006
Last updated
07/09/2007
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