Provider Demographics
NPI:1659695104
Name:DOCKERY, MARY C (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-0303
Mailing Address - Country:US
Mailing Address - Phone:508-785-5184
Mailing Address - Fax:
Practice Address - Street 1:99 ACCESS RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5211
Practice Address - Country:US
Practice Address - Phone:781-551-8002
Practice Address - Fax:781-551-8004
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266010363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health