Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1346695269 |
---|---|
Provider Name | Ariana Geisse |
First Address | Bridgewater, MA 02324-8122 |
Second Address | Bridgewater, MA 02324-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |