Provider Demographics
NPI:1871652099
Name:REED, MARY THERESA (RN, NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:REED
Suffix:
Gender:F
Credentials:RN, 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 415358
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:508-334-1000
Mailing Address - Fax:
Practice Address - Street 1:159 UNION ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1274
Practice Address - Country:US
Practice Address - Phone:508-624-9688
Practice Address - Fax:508-624-9689
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner