Individual
MS. KATHLEEN MARY MCIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
19 NEPONSET AVE, HYDE PARK, MA 02136-3432
(617) 333-9825
Mailing address
194 WARREN AVE, WHITMAN, MA 02382-1227
(781) 447-2880
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
38298
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0710725
PROVIDER MASS HEALTH
MA
Enumeration date
03/29/2007
Last updated
07/08/2007
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