Provider Demographics
NPI:1164991766
Name:LOUCKS, MARYELLEN FALVEY (RN)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:FALVEY
Last Name:LOUCKS
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 1:66 MORGAN WAY
Mailing Address - Street 2:
Mailing Address - City:W BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668-1847
Mailing Address - Country:US
Mailing Address - Phone:508-420-3240
Mailing Address - Fax:
Practice Address - Street 1:66 MORGAN WAY
Practice Address - Street 2:
Practice Address - City:W BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02668-1847
Practice Address - Country:US
Practice Address - Phone:508-420-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175206163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse