Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 179735 | MA |
NPI | 1013198431 |
---|---|
Provider Name | Jacqueline Kennedy-Harte |
First Address | Boston, MA 02132-2137 |
Second Address | Boston, MA 02115-6105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 14/11/2007 |