Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN2294906 | MA |
NPI | 1073981155 |
---|---|
Provider Name | Alexsis Walter |
First Address | Andover, MA 01810-4501 |
Second Address | Andover, MA 01810-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2015 |
Last Update Date | 08/09/2015 |