Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN2308245 | MA |
NPI | 1043738321 |
---|---|
Provider Name | Jenna Larson |
First Address | Danvers, MA 01923-2256 |
Second Address | Danvers, MA 01923-2256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |