Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 202017741 | MA |
NPI | 1023627833 |
---|---|
Provider Name | Jennifer Suxin Yu |
First Address | Malden, MA 02148-3647 |
Second Address | Malden, MA 02148-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 28/07/2020 |