Provider Demographics
NPI:1124232277
Name:POWERS, MARY JANE (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:POWERS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3519
Mailing Address - Country:US
Mailing Address - Phone:617-471-2599
Mailing Address - Fax:
Practice Address - Street 1:120 BOYLSTON ST
Practice Address - Street 2:EMERSON COLLEGE CENTER FOR HEALTH & WELLNESS
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4611
Practice Address - Country:US
Practice Address - Phone:617-824-8666
Practice Address - Fax:617-824-7897
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA129508363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health