Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN2329059 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2329059 | MA |
NPI | 1013513837 |
---|---|
Provider Name | Janina Marie Colavita |
First Address | Quincy, MA 02169-7337 |
Second Address | Brockton, MA 02301-4042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 24/08/2021 |