Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 272452 | MA |
N | 363LG0600X | Nurse Practitioner - Gerontology | F340239 | NY |
NPI | 1013139955 |
---|---|
Provider Name | Ann Marie Edson |
First Address | Maynard, MA 01754-0000 |
Second Address | Maynard, MA 01754-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S 87728 | (02) | NY |