Individual
MS. KELLY HELEN PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MSN,BC
Contact information
Practice address
1400 VFW PKWY, WEST ROXBURY, MA 02132-4927
(617) 323-7700
Mailing address
8 PIERRE VERNIER DRIVE, MASHPEE, MA 02649
(508) 360-4008
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
234648
MA
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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