Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 5133 | MA |
NPI | 1194940965 |
---|---|
Provider Name | Alice Mazzaferro |
First Address | Monson, MA 01057-9438 |
Second Address | Springfield, MA 01104-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0317624 | (05) | MA |