Healthcare Provider Details

I. General information

NPI: 1720113111
Provider Name (Legal Business Name): PHYLLIS ANNE MAGUIRE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VICTORY RD
QUINCY MA
02171-3139
US

IV. Provider business mailing address

3 SHETLAND
PLYMOUTH MA
02360-2471
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-1040
  • Fax:
Mailing address:
  • Phone: 508-209-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number121574
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: