Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN2288832 | MA |
NPI | 1013561570 |
---|---|
Provider Name | Kellie Olsen |
First Address | Lawrence, MA 01843 |
Second Address | Lawrence, MA 01843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 01/08/2019 |