Individual
TAYNE S ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-5636
Mailing address
9 MOUNT VERNON ST APT 1, DORCHESTER, MA 02125-1791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA100112
MA
363AM0700X
Medical Physician Assistant
Primary
PA100112
MA
Other
Enumeration date
12/13/2023
Last updated
04/29/2024
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