Provider Demographics
NPI:1780927756
Name:LORING, MARTHA DIETZ (RN, NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:DIETZ
Last Name:LORING
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 WARREN AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5975
Mailing Address - Country:US
Mailing Address - Phone:646-596-4122
Mailing Address - Fax:
Practice Address - Street 1:189 WARREN AVE
Practice Address - Street 2:APT 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5975
Practice Address - Country:US
Practice Address - Phone:646-596-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2277277163W00000X
MARN2277277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse