Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 157069 | MA |
NPI | 1053460584 |
---|---|
Provider Name | Joanna G Peatfield |
First Address | Lawrence, MA 01843-1764 |
Second Address | Lawrence, MA 01843-1764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 28/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
568275 | (02) | MA |