Individual
MARIE NINIVE SOUFFRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
491 METROPOLITAN AVE, HYDE PARK, MA 02136-3220
(617) 365-4871
Mailing address
491 METROPOLITAN AVE, HYDE PARK, MA 02136-3220
(617) 365-4871
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
67369
MA
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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