Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 127457 | MA |
NPI | 1013130921 |
---|---|
Provider Name | Diane Marie Poulin |
First Address | Newton, MA 02462-1607 |
Second Address | Newton, MA 02462-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |