Healthcare Provider Details

I. General information

NPI: 1730563636
Provider Name (Legal Business Name): MRS. MARY CHEVALIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108A NORTH MAIN STREET SERVICENET REACH
SUNDERLAND MA
01375-9502
US

IV. Provider business mailing address

108A NORTH MAIN STREET SERVICENET REACH
SUNDERLAND MA
01375-9502
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 413-665-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: