Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN2291642 | MA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN2291642 | MA |
NPI | 1013407147 |
---|---|
Provider Name | Alisa Shaulskaya |
First Address | Tewksbury, MA 01876-3315 |
Second Address | Wilmington, MA 01887-2179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN2291642 | (05) | MA |