Provider Demographics
NPI:1447408737
Name:HACKEL, MARY E (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:HACKEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02142-4705
Mailing Address - Country:US
Mailing Address - Phone:781-891-2222
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4713
Practice Address - Country:US
Practice Address - Phone:781-891-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily