Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2287185 | MA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN2287185 | MA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN2287185 | MA |
NPI | 1083263602 |
---|---|
Provider Name | Kaylie Elizabeth Dygon |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 29/06/2020 |