Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD032103E | PA |
NPI | 1063474989 |
---|---|
Provider Name | Katherine Murray Leisure |
First Address | Teaticket, MA 02536-2460 |
Second Address | Plymouth, MA 02360-8710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110089905A | (05) | MA |