Provider Demographics
NPI:1811569825
Name:LANDRETH, ENID S (RN)
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:S
Last Name:LANDRETH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:111 LOCUST ST APT 40-B1
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3871
Mailing Address - Country:US
Mailing Address - Phone:617-840-6561
Mailing Address - Fax:
Practice Address - Street 1:111 LOCUST ST APT 40-B1
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3871
Practice Address - Country:US
Practice Address - Phone:617-840-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2287542163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse