Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | S09981228 | MA |
NPI | 1376217182 |
---|---|
Provider Name | Kayla Tudryn |
First Address | Chicopee, MA 01020-4031 |
Second Address | Chicopee, MA 01020-4031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2021 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100043969219 | (05) | MA |