Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 182128 | MA |
NPI | 1013064419 |
---|---|
Provider Name | Deborah A Davolio |
First Address | Boston, MA 02241-0001 |
Second Address | Boston, MA 02118-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0358941NP | (05) | MA |
NP2699 | BCBS (01) | MA |
P14015 | (02) | MA |