Individual
ROBERT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
165 CAMBRIDGE ST STE 501, BOSTON, MA 02114-2759
(617) 726-4900
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN57497
MA
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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