Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 246688 | MA |
NPI | 1114123312 |
---|---|
Provider Name | Bethany Ondrick |
First Address | Springfield, MA 01118-2533 |
Second Address | Springfield, MA 01118-2533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |