Individual
MS. MARILYN S. C. MOREIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
167 DEANNA RD, BROCKTON, MA 02302-4427
(508) 587-1430
Mailing address
167 DEANNA RD, BROCKTON, MA 02302-4427
(508) 587-1430
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
54176
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717835
MASSHEALTH PROVIDER NUMBER
MA
Enumeration date
08/29/2008
Last updated
08/29/2008
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