Provider Demographics
NPI:1164521068
Name:ELDRIDGE, MARY SHARON (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SHARON
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:172 CAMBRIDGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2984
Practice Address - Country:US
Practice Address - Phone:781-272-7022
Practice Address - Fax:781-272-8786
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23649OtherLPN LICENSE