Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 287050 | MA |
Y | 208600000X | Surgeon | 287050 | MA |
NPI | 1003233560 |
---|---|
Provider Name | Dr. Joanna Wolf Etra |
First Address | Boston, MA 02215-5501 |
Second Address | Boston, MA 02215-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2014 |
Last Update Date | 25/06/2021 |