Healthcare Provider Details

I. General information

NPI: 1134526676
Provider Name (Legal Business Name): MABOH ACHIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N PEARL ST
BROCKTON MA
02301-1101
US

IV. Provider business mailing address

2340 GAR HWY
SWANSEA MA
02777-3907
US

V. Phone/Fax

Practice location:
  • Phone: 781-492-5456
  • Fax:
Mailing address:
  • Phone: 781-492-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN259533
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: