Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN2284089 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2284089 | MA |
NPI | 1073922464 |
---|---|
Provider Name | Ashley Aren Smith-Boutin |
First Address | Groton, MA 01450-1879 |
Second Address | Groton, MA 01450-1879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2014 |
Last Update Date | 04/08/2016 |