Individual
EDDIE KEVIN MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 442-2853
(774) 443-7042
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2297770
MA
363LP0200X
Pediatric Nurse Practitioner
5790
CT
363LP0200X
Pediatric Nurse Practitioner
RN2297770
MA
Other
Enumeration date
08/05/2014
Last updated
02/11/2015
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