Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 63611 | WI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 270303 | MA |
N | 2080P0203X | Pediatric Critical Care Doctor | 63611 | WI |
NPI | 1003159336 |
---|---|
Provider Name | Cailyn Hereen Rood |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003159336 | (05) | WI |