Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN2329573 | MA |
NPI | 1023620507 |
---|---|
Provider Name | Kayla Maloney |
First Address | Windham, NH 03087-1251 |
Second Address | Windham, NH 03087-1251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2020 |
Last Update Date | 17/08/2020 |