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General NPI Number Information
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NPI Number | 1790013910
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Entity Type | Individual
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Provider Name | MARI AGNES STACKPOOLE NP
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Gender | Female
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Dates
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Enumeration Date | 11/28/2009
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 1261 FURNACE BROOK PKWY SUITE 30-31
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City | QUINCY
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State | MA
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Zip | 02169-4721
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Country | US
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Telephone | 617-479-4545
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Fax | 617-479-4555
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Provider Business Mailing Address
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Address Line | 1261 FURNACE BROOK PKWY SUITE 30-31
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City | QUINCY
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State | MA
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Zip | 02169-4721
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Country | US
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Telephone | 617-479-4545
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Fax | 617-479-4555
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 280880
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 280880
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 280880
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License Number State | MA
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