Provider Demographics
NPI:1134254667
Name:KUGLER, MARY (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KUGLER
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 1:14B TRULL ST # 4
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2126
Mailing Address - Country:US
Mailing Address - Phone:617-275-1139
Mailing Address - Fax:
Practice Address - Street 1:14B TRULL ST # 4
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2126
Practice Address - Country:US
Practice Address - Phone:617-275-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212181163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0328626Medicaid