Provider Demographics
NPI:1952647117
Name:MCCAULEY- LAURENT, MAUDELL LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAUDELL
Middle Name:LOUISE
Last Name:MCCAULEY- LAURENT
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 1:549 ASHMONT ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2320
Mailing Address - Country:US
Mailing Address - Phone:617-282-5054
Mailing Address - Fax:
Practice Address - Street 1:549 ASHMONT ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2320
Practice Address - Country:US
Practice Address - Phone:617-282-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN262541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse