Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP2300X | Nurse Practitioner - Primary Care | RN2328557 | MA |
NPI | 1043783608 |
---|---|
Provider Name | Jaya Rawla |
First Address | Worcester, MA 01605-3516 |
Second Address | Worcester, MA 01605-3516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 21/01/2021 |