Provider Demographics
NPI:1215351648
Name:LABUE, MARY ANN (EDD)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:LABUE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2689
Mailing Address - Country:US
Mailing Address - Phone:508-420-2662
Mailing Address - Fax:
Practice Address - Street 1:8 BOBWHITE LN
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2689
Practice Address - Country:US
Practice Address - Phone:508-420-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA453105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist