Provider Demographics
NPI:1215175849
Name:FREY, MARY KENNELLY (GNP - BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KENNELLY
Last Name:FREY
Suffix:
Gender:F
Credentials:GNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 WINTER ST
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1424
Mailing Address - Country:US
Mailing Address - Phone:781-472-8569
Mailing Address - Fax:781-472-9802
Practice Address - Street 1:950 WINTER ST
Practice Address - Street 2:SUITE 3800
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1424
Practice Address - Country:US
Practice Address - Phone:781-472-8569
Practice Address - Fax:781-472-9802
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RINP36928363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology