Individual
MISS CHAROUNIPHA SOYDARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
55 FRUIT ST, BIGELOW 800, BOSTON, MA 02114-2621
(617) 726-2000
Mailing address
55 FRUIT ST, BIGELOW 800, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2285282
MA
363LF0000X
Family Nurse Practitioner
APRN00801
RI
Other
Enumeration date
01/07/2016
Last updated
03/25/2016
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