Individual
MISS MICHELLE ANN TACKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
75 COMO RD, HYDE PARK, MA 02136-1904
(617) 953-5058
(617) 364-7198
Mailing address
75 COMO RD, HYDE PARK, MA 02136-1904
(617) 953-5058
(617) 364-7198
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
S34977173
MA
Other
Enumeration date
02/07/2013
Last updated
02/07/2013
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