Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN2281790 | MA |
NPI | 1023424348 |
---|---|
Provider Name | Holly Mcclure |
First Address | Charlton, MA 01507-1394 |
Second Address | Charlton, MA 01507-1394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |