Active NPI
Marilyn S. C. Moreira, LPN
- Licensed Practical Nurse
- Brockton, MA
National Provider Identifier
1902054166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 54176
- Practice address
- 167 Deanna Rd
Brockton, MA 02302-4427 - Phone
- (508) 587-1430
- NPI assigned
- Aug 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 54176 | MA | Primary |
Addresses
Primary practice location
167 Deanna Rd
Brockton, MA 02302-4427
Mailing address
167 Deanna Rd
Brockton, MA 02302-4427
Phone (508) 587-1430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0717835 | Other | MA | MASSHEALTH PROVIDER NUMBER |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219968000000",
"number": "1902054166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167 DEANNA RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023024427",
"telephone_number": "508-587-1430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 DEANNA RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023024427",
"telephone_number": "508-587-1430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOREIRA",
"first_name": "MARILYN",
"middle_name": "S. C.",
"name_prefix": "Ms.",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-29",
"last_updated": "2008-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "54176",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSHEALTH PROVIDER NUMBER",
"identifier": "0717835",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.