Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN2299335 | MA |
NPI | 1326495151 |
---|---|
Provider Name | Kara Pesola |
First Address | Salem, MA 01970-3218 |
Second Address | Salem, MA 01970-7308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 14/09/2016 |