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NPI Code Detail

MEDICARE: QUILNINIOUS RANDALL

MEDICARE: QUILNINIOUS RANDALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2251E00000XHome Health Agency

General Provider Information

NPI Number : 1467805184
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUILNINIOUS RANDALL
Provider Business Mailing Address
First Line : 3313 WASHINGTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02130-2691
Country : US
Telephone Number : 508-789-2365
Fax Number :
Provider Business Practice Location Address
First Line : 3313 WASHINGTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02130-2691
Country : US
Telephone Number : 508-789-2365
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2016
Last Update Date : 07/18/2016

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Directions to “ QUILNINIOUS RANDALL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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