Healthcare Provider Details

I. General information

NPI: 1629385992
Provider Name (Legal Business Name): LOIS M KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ELM AVE
HYANNIS MA
02601-5547
US

IV. Provider business mailing address

1135 MORTON ST
MATTAPAN MA
02126-2834
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-0300
  • Fax: 508-778-0301
Mailing address:
  • Phone: 617-533-2300
  • Fax: 617-533-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN168443
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: