Provider Demographics
NPI:1851645667
Name:BOISVERT, MARY ANTOINETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANTOINETTE
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WERKING RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-9302
Mailing Address - Country:US
Mailing Address - Phone:518-477-6830
Mailing Address - Fax:
Practice Address - Street 1:55 WERKING RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-9302
Practice Address - Country:US
Practice Address - Phone:518-477-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY378156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse