Individual
THERESA LYDIA DEROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
753 NW MAIN ST, DOUGLAS, MA 01516-2802
(508) 476-1112
(508) 476-2444
Mailing address
753 NW MAIN ST, DOUGLAS, MA 01516-2802
(508) 476-1112
(508) 476-2444
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
175554
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0708119
—
MA
Enumeration date
03/13/2007
Last updated
07/09/2007
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