Healthcare Provider Details

I. General information

NPI: 1831158716
Provider Name (Legal Business Name): MARY E GARBOSKI APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-17 WARREN ST
LOWELL MA
01852
US

IV. Provider business mailing address

585 597 MERRIMACK STREET LOWELL COMMUNITY HEALTH CENTER
LOWELL MA
01854
US

V. Phone/Fax

Practice location:
  • Phone: 978-934-0164
  • Fax: 978-452-2143
Mailing address:
  • Phone: 978-934-0164
  • Fax: 978-452-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number137570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: