Active NPI
Edder Geovanny Mora
- Licensed Practical Nurse
- Lawrence, MA
National Provider Identifier
1790469781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LN101085
- Practice address
- 360 Merrimack St Ste 9
Lawrence, MA 01843-1764 - Phone
- (978) 655-6652
- Fax
- (833) 963-2112
- NPI assigned
- Jun 12, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LN101085 | MA | Primary |
Addresses
Primary practice location
360 Merrimack St Ste 9
Lawrence, MA 01843-1764
Mailing address
87 Phillips St
Methuen, MA 01844-4311
Phone (978) 835-5358
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LN101085 | MA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686528000000",
"number": "1790469781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 PHILLIPS ST",
"city": "METHUEN",
"state": "MA",
"postal_code": "018444311",
"telephone_number": "978-835-5358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 MERRIMACK ST STE 9",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018431764",
"telephone_number": "978-655-6652",
"fax_number": "833-963-2112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORA",
"first_name": "EDDER",
"middle_name": "GEOVANNY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-12",
"last_updated": "2023-06-12",
"certification_date": "2023-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "LN101085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.