Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN2267925 | MA |
NPI | 1053950774 |
---|---|
Provider Name | Caitlin Betelak |
First Address | Southborough, MA 01772-1748 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2019 |
Last Update Date | 28/12/2019 |