Basic Information
Provider Information
NPI: 1447719265
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALCE
FirstName: MIRYAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 60 LAURA LN
Address2:  
City: STOUGHTON
State: MA
PostalCode: 020723330
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 398 NEPONSET AVE
Address2:  
City: DORCHESTER
State: MA
PostalCode: 021223150
CountryCode: US
TelephoneNumber: 6172823200
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/19/2019
LastUpdateDate: 06/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN2276870MAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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