Provider Demographics
NPI:1942321054
Name:LALLY, HENRY WILLIAM (RN)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:WILLIAM
Last Name:LALLY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8029
Mailing Address - Country:US
Mailing Address - Phone:781-964-1809
Mailing Address - Fax:
Practice Address - Street 1:44 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-8029
Practice Address - Country:US
Practice Address - Phone:781-964-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198226163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse