Healthcare Provider Details

I. General information

NPI: 1568068559
Provider Name (Legal Business Name): MARIA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HIGHLAND AVE
SOMERVILLE MA
02143-1408
US

IV. Provider business mailing address

45 NASHUA RD
NORTH BILLERICA MA
01862-2004
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-4800
  • Fax:
Mailing address:
  • Phone: 617-458-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN2289632
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN2289632
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: