Provider Demographics
NPI:1194561233
Name:ADDY, EMELIA
Entity type:Individual
Prefix:
First Name:EMELIA
Middle Name:
Last Name:ADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:CHARLTON CITY
Mailing Address - State:MA
Mailing Address - Zip Code:01508-0814
Mailing Address - Country:US
Mailing Address - Phone:508-332-6386
Mailing Address - Fax:
Practice Address - Street 1:60 CITY DEPOT RD UNIT 301
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5472
Practice Address - Country:US
Practice Address - Phone:508-332-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN98829164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse