Provider Demographics
NPI:1881704260
Name:REILLY, RITA M (RN)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:REILLY
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 1:10 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3866
Mailing Address - Country:US
Mailing Address - Phone:978-630-4740
Mailing Address - Fax:
Practice Address - Street 1:10 PARKER ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3866
Practice Address - Country:US
Practice Address - Phone:978-630-4740
Practice Address - Fax:978-630-4765
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102828163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health