Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 275375 | MA |
NPI | 1083923130 |
---|---|
Provider Name | Jillian Marie Kelly |
First Address | Medford, MA 02155-4754 |
Second Address | Medford, MA 02155-4754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 27/03/2021 |