Individual
KETMA PERICLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(781) 397-6546
Mailing address
36 TEA PARTY WAY, MALDEN, MA 02148-1980
(781) 922-1097
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN69424
MA
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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