Healthcare Provider Details

I. General information

NPI: 1780927756
Provider Name (Legal Business Name): MARTHA DIETZ LORING RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 WARREN AVE APT 3
BOSTON MA
02116-5975
US

IV. Provider business mailing address

189 WARREN AVE APT 3
BOSTON MA
02116-5975
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-4122
  • Fax:
Mailing address:
  • Phone: 646-596-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2277277
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2277277
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: