Provider Demographics
NPI:1912753898
Name:LORD, MASHA (RN)
Entity type:Individual
Prefix:
First Name:MASHA
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:KHAZANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190R SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1431
Mailing Address - Country:US
Mailing Address - Phone:857-231-0093
Mailing Address - Fax:
Practice Address - Street 1:391 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2119
Practice Address - Country:US
Practice Address - Phone:978-674-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2366505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse