License holder summary

Audrey M Provenzano is a Board Of Registration In Medicine licensed to practice in Massachusetts. The address on file for Audrey M Provenzano is Dimock Community Health Center, 55 Dimock St, ROXBURY 02119. This licensed professional license is current. The license was granted 11/07/2012 and expired on 04/24/2017.

Massachusetts

Division of Professional Licensure

Audrey M Provenzano
Board Of Registration In Medicine
License number
253623
Date granted
11/07/2012
Date expires
04/24/2017
Class
Board Of Registration In Medicine
Status
Active
Address
Dimock Community Health Center, 55 Dimock St
licensingma.org
ID 41468502
LAST UPDATED 2024-02-25 05:03:44 UTC

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