Individual
JUSTINE MCMAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
165 QUINCY ST, BROCKTON, MA 02302-2988
(508) 597-2092
Mailing address
11 HOLLY RD, WALPOLE, MA 02081-3614
(508) 380-0794
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN94416
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LN94416
MASSACHUSETTS OF PUBLIC HEALTH-BOARD OF REGISTRATION IN NURSING
MA
Enumeration date
08/28/2017
Last updated
08/28/2017
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