Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN02465 | RI |
NPI | 1053903443 |
---|---|
Provider Name | Holly Berthod |
First Address | Pascoag, RI 02859-3103 |
Second Address | Pascoag, RI 02859-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2021 |
Last Update Date | 23/06/2021 |