Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 241581 | MA |
N | 208600000X | Surgeon | 241581 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 15865 | ND |
NPI | 1225264104 |
---|---|
Provider Name | Jeena Easow |
First Address | Boston, MA 02118-2526 |
Second Address | Fargo, ND 58104-7927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 10/10/2019 |