Provider Demographics
NPI:1104652593
Name:LAYNE, AGATHA
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:LAYNE
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3529
Mailing Address - Country:US
Mailing Address - Phone:857-233-1518
Mailing Address - Fax:
Practice Address - Street 1:26 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-3529
Practice Address - Country:US
Practice Address - Phone:857-233-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN281221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse