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General NPI Number Information
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NPI Number | 1376406314
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Entity Type | Individual
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Provider Name | MARY IMMACULATE NANKYA MHNP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 241 LEXINGTON ST # 5
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City | WOBURN
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State | MA
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Zip | 01801-5945
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Country | US
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Telephone | 857-352-7186
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Fax |
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Provider Business Mailing Address
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Address Line | 241 LEXINGTON ST # 5
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City | WOBURN
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State | MA
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Zip | 01801-5945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2357600
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License Number State | MA
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