Provider Demographics
NPI:1083213698
Name:MARONEY, KERRI E (RN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:E
Last Name:MARONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SURREY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2635
Mailing Address - Country:US
Mailing Address - Phone:401-835-5683
Mailing Address - Fax:
Practice Address - Street 1:72 SURREY ST APT 3
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2635
Practice Address - Country:US
Practice Address - Phone:401-835-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339320163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Single Specialty