Provider Demographics
NPI:1881036325
Name:MACEY, LORETTA THERESIA (RN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:THERESIA
Last Name:MACEY
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 1:109 PONEMAH ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-249-5771
Mailing Address - Fax:
Practice Address - Street 1:109 PONEMAH RD
Practice Address - Street 2:SUITE 9
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2834
Practice Address - Country:US
Practice Address - Phone:603-249-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH028745-21163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy