Healthcare Provider Details

I. General information

NPI: 1922209378
Provider Name (Legal Business Name): MARYMARGARET WINTER R.N.B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GOVERNORS AVE
MEDFORD MA
02155-1643
US

IV. Provider business mailing address

128 ROCKLAND AVE.
MALDEN MA
02148
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-6859
  • Fax: 781-306-6842
Mailing address:
  • Phone: 781-321-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number95139
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: