Healthcare Provider Details

I. General information

NPI: 1801942768
Provider Name (Legal Business Name): MRS. PALM LORRAINE RIPOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CLINICS ONE
BOSTON MA
01450
US

IV. Provider business mailing address

31 SAWTELL DR
GROTON MA
01450-1490
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-3427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number172002
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: