Healthcare Provider Details

I. General information

NPI: 1447841242
Provider Name (Legal Business Name): MARYANNE SHECKMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DALE ST
SWAMPSCOTT MA
01907-1404
US

IV. Provider business mailing address

12 DALE ST
SWAMPSCOTT MA
01907-1404
US

V. Phone/Fax

Practice location:
  • Phone: 978-500-2768
  • Fax:
Mailing address:
  • Phone: 978-500-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number181990
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN181990
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: