Individual
JOANN M NILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
5 COUNTY ST, LAKEVILLE, MA 02347-1808
(508) 923-7040
Mailing address
5 COUNTY ST, LAKEVILLE, MA 02347-1808
(508) 923-7040
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
141082
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0355607
MASSHEALTH PROVIDER
MA
Enumeration date
03/28/2007
Last updated
07/08/2007
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