Provider Demographics
NPI:1164845129
Name:LOURES, MIRELLA
Entity Type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:LOURES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6107
Mailing Address - Country:US
Mailing Address - Phone:508-857-6149
Mailing Address - Fax:
Practice Address - Street 1:98 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6107
Practice Address - Country:US
Practice Address - Phone:508-857-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide