Provider Demographics
NPI:1710106208
Name:FAVORITO, JOHN D (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:FAVORITO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LACKEY ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3207
Mailing Address - Country:US
Mailing Address - Phone:508-579-4686
Mailing Address - Fax:
Practice Address - Street 1:35 LACKEY ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3207
Practice Address - Country:US
Practice Address - Phone:508-579-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130991163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0711551OtherPROVIDER NUMBER