Provider Demographics
NPI:1699292839
Name:MCMAHON, JUSTINE (LPN)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3614
Mailing Address - Country:US
Mailing Address - Phone:508-380-0794
Mailing Address - Fax:
Practice Address - Street 1:165 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2988
Practice Address - Country:US
Practice Address - Phone:508-597-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN94416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALN94416OtherMASSACHUSETTS OF PUBLIC HEALTH-BOARD OF REGISTRATION IN NURSING