Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 128488 | MA |
NPI | 1013033430 |
---|---|
Provider Name | Joan Rosa |
First Address | Hanover, MA 02339-1227 |
Second Address | Hanover, MA 02339-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 27/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128488 | NP LICENSE # (01) | MA |