Provider Demographics
NPI:1811404080
Name:MUTO, MARIO ROBERT (LPN)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ROBERT
Last Name:MUTO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1748
Mailing Address - Country:US
Mailing Address - Phone:508-634-3420
Mailing Address - Fax:
Practice Address - Street 1:32 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1748
Practice Address - Country:US
Practice Address - Phone:508-634-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN92540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse