Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2306763 | MA |
NPI | 1003324849 |
---|---|
Provider Name | Katherine E Serra |
First Address | Boston, MA 02134-2221 |
Second Address | Fall River, MA 02720-6009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 04/12/2020 |