Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN2277785 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2277785 | MA |
NPI | 1063834109 |
---|---|
Provider Name | Christine Engle |
First Address | Boston, MA 02118-1040 |
Second Address | Boston, MA 02118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 22/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110117251A | (05) | MA |