Individual
MISS MARI AGNES STACKPOOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1261 FURNACE BROOK PKWY, SUITE 30-31, QUINCY, MA 02169-4721
(617) 479-4545
(617) 479-4555
Mailing address
1261 FURNACE BROOK PKWY, SUITE 30-31, QUINCY, MA 02169-4721
(617) 479-4545
(617) 479-4555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
280880
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
280880
MA
363LG0600X
Gerontology Nurse Practitioner
280880
MA
Other
Enumeration date
11/28/2009
Last updated
01/09/2020
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