Healthcare Provider Details

I. General information

NPI: 1225139819
Provider Name (Legal Business Name): KERI-ANN MAGUIRE N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SALISBURY ST STUDENT HEALTH SERVICES
WORCESTER MA
01609-1265
US

IV. Provider business mailing address

46B E WALNUT ST
MILFORD MA
01757-3548
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-7329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number255039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: