Individual
MARY FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 CENTRAL ST, SOMERVILLE, MA 02143-2827
(617) 665-3370
Mailing address
25 BRAINTREE HILL PARK STE 101, BRAINTREE, MA 02184-8715
(781) 971-5019
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN29107
MA
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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