Provider Demographics
NPI:1629357900
Name:DECESARE-FLAHERTY, MARY K (NPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:DECESARE-FLAHERTY
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2751
Mailing Address - Country:US
Mailing Address - Phone:507-756-6293
Mailing Address - Fax:508-756-9404
Practice Address - Street 1:25 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2751
Practice Address - Country:US
Practice Address - Phone:507-756-6293
Practice Address - Fax:508-756-9404
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner