Basic Information
| Provider Information | |||||||||
| NPI: | 1124664107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUILTY | ||||||||
| FirstName: | ANNMARY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 COMMERCE DR UNIT 2311 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021847159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176804187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 MOUNT VERNON ST | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021253120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172881140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2019 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN2332013 | MA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.