Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 145299 | MA |
NPI | 1003840331 |
---|---|
Provider Name | Jean R O'farrell |
First Address | Tewksbury, MA 01876-1950 |
Second Address | Tewksbury, MA 01876-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |