Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN264192 | MA |
NPI | 1144574674 |
---|---|
Provider Name | Caitlin Johnson |
First Address | Milton, MA 02186-4105 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 19/08/2013 |