Provider Demographics
NPI:1356793715
Name:NELLIGAN, MARY BRIDGET (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BRIDGET
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BRIDGET
Other - Last Name:KAVANAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:119 WINDSOR ST
Mailing Address - Street 2:CAMBRIDGE HEALTH DEPARTMENT
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-665-3800
Mailing Address - Fax:617-665-3888
Practice Address - Street 1:119 WINDSOR ST
Practice Address - Street 2:CAMBRIDGE HEALTH DEPARTMENT
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-665-3800
Practice Address - Fax:617-665-3888
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN134126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse