Provider Demographics
NPI:1104466275
Name:LORTIE, MARY CLAIRE (MS, CNP, RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:LORTIE
Suffix:
Gender:F
Credentials:MS, CNP, RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CLAIRE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10 VERNON ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4930
Mailing Address - Country:US
Mailing Address - Phone:508-612-5591
Mailing Address - Fax:
Practice Address - Street 1:10 VERNON ST UNIT 302
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4930
Practice Address - Country:US
Practice Address - Phone:508-612-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129158363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics