Provider Demographics
NPI:1225030174
Name:SPAIN, MARY LOUISE (RNCS)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:SPAIN
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6621
Mailing Address - Country:US
Mailing Address - Phone:978-462-2890
Mailing Address - Fax:978-462-2890
Practice Address - Street 1:143 STATE ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-6621
Practice Address - Country:US
Practice Address - Phone:978-462-2890
Practice Address - Fax:978-462-2890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97559163WP0808X
MAMS03596491163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS0415Medicare ID - Type Unspecified