Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 277386 | MA |
NPI | 1023390655 |
---|---|
Provider Name | Caitlin Marie Dacey |
First Address | Jamaica Plain, MA 02130-1401 |
Second Address | Jamaica Plain, MA 02130-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 09/09/2011 |