Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 96723 | MA |
NPI | 1003459371 |
---|---|
Provider Name | Dr. Elizabeth Connelly Kudzma |
First Address | Marshfield, MA 02050-1775 |
Second Address | Marshfield, MA 02050-1775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2019 |
Last Update Date | 19/10/2019 |