MEDICARE: MS. LAURA LOGUE ROOD APRN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	110370	MA

General Provider Information

NPI Number	:	1184767410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA LOGUE ROOD APRN, BC

Provider Business Mailing Address
First Line	:	23 BAY ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3144
Country	:	US
Telephone Number	:	617-626-9459
Fax Number	:	617-626-9591

Provider Business Practice Location Address
First Line	:	180 MORTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02130-3735
Country	:	US
Telephone Number	:	617-626-9459
Fax Number	:	617-626-9591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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