Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 123070 | MA |
NPI | 1043271745 |
---|---|
Provider Name | Jean Canty Schwartz |
First Address | Falmouth, MA 02540-2342 |
Second Address | Falmouth, MA 02540-2325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP2818 | BLUE SHIELD (01) | MA |
P22352 | (02) | MA |