Individual
KELSEY STANVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(978) 846-0753
Mailing address
800 WASHINGTON ST, BOSTON, MA 02111-1552
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6975
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/15/2019
Last updated
10/22/2020
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