Provider Demographics
NPI:1457163487
Name:EDWIN-JOHNSON AZUTA, MAUREEN A (BA, MPH, BSN, PHD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:EDWIN-JOHNSON AZUTA
Suffix:
Gender:F
Credentials:BA, MPH, BSN, PHD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:WAGBARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MPH, BSN, PHD
Mailing Address - Street 1:28 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1937
Mailing Address - Country:US
Mailing Address - Phone:617-953-2975
Mailing Address - Fax:
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1937
Practice Address - Country:US
Practice Address - Phone:617-953-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276014163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse