Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 340312 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN2321628 | MA |
NPI | 1003204652 |
---|---|
Provider Name | Grace Marie Carver |
First Address | Boston, MA 02118-3654 |
Second Address | Roxbury, MA 02119-1208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 27/01/2020 |