Individual
MAI PHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1400 VFW PKWY, WEST ROXBURY, MA 02132-4927
(857) 203-6700
Mailing address
66 FALMOUTH RD, NEWTON, MA 02465-1127
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN237675
MA
Other
Enumeration date
06/06/2013
Last updated
12/09/2020
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