Healthcare Provider Details

I. General information

NPI: 1841109667
Provider Name (Legal Business Name): MARYELLEN SPILLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WILLOW RIDGE DR
BRIDGEWATER MA
02324-2449
US

IV. Provider business mailing address

41 WILLOW RIDGE DR
BRIDGEWATER MA
02324-2449
US

V. Phone/Fax

Practice location:
  • Phone: 508-942-7056
  • Fax:
Mailing address:
  • Phone: 508-942-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN186595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: