Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | NOT YET ISSUED | KY |
N | 208600000X | Surgeon | NOT YET ISSUED | KY |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 282059 | MA |
N | 2086S0122X | Plastic and Reconstructive Surgery | R3419 | KY |
NPI | 1235544602 |
---|---|
Provider Name | Ashley Boustany |
First Address | Boston, MA 02215-5566 |
Second Address | Boston, MA 02215-5566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 29/04/2021 |