Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 197007 | MA |
NPI | 1043427503 |
---|---|
Provider Name | Julia Goon Lee |
First Address | Chestnut Hill, MA 02467-3001 |
Second Address | Boston, MA 02111-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1213288 | (05) | MA |