Healthcare Provider Details

I. General information

NPI: 1255240099
Provider Name (Legal Business Name): MARIE MICHELLE ZEPHYR
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

18 RUGBY RD APT 2
MATTAPAN MA
02126-3209
US

IV. Provider business mailing address

18 RUGBY RD APT 2
MATTAPAN MA
02126-3209
US

V. Phone/Fax

Practice location:
  • Phone: 617-980-1873
  • Fax:
Mailing address:
  • Phone: 617-980-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN1004141
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: