Individual
STANLEY GERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
454 BROADWAY, REVERE, MA 02151-3034
(781) 485-8282
Mailing address
454 BROADWAY, REVERE, MA 02151-3034
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
232231
MA
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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