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General NPI Number Information
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NPI Number | 1952710097
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Entity Type | Individual
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Provider Name | MARY BRIDGET MCCORMACK MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2014
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Last Update Date | 08/02/2014
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Provider Practice Location Address
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Address Line | 25 WINTHROP RD
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City | HINGHAM
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State | MA
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Zip | 02043-3532
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Country | US
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Telephone | 857-204-9076
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Fax |
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Provider Business Mailing Address
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Address Line | 25 WINTHROP RD
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City | HINGHAM
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State | MA
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Zip | 02043-3532
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2263960
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License Number State | MA
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